{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T12:09:09Z","timestamp":1785413349878,"version":"3.56.0"},"reference-count":67,"publisher":"MDPI AG","issue":"15","license":[{"start":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T00:00:00Z","timestamp":1785369600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100000780","name":"European Union","doi-asserted-by":"publisher","award":["PRIN 2022\u2014D.D. 104\/2022\u2014DIKA EMI\u2014Fin. NextGenerationEU\u2014PNRR\u2014M4C2\u2014Inv. 1.1\u2014Cod. prog. 2022RY8549_002\u2014CUP J53D23003260006"],"award-info":[{"award-number":["PRIN 2022\u2014D.D. 104\/2022\u2014DIKA EMI\u2014Fin. NextGenerationEU\u2014PNRR\u2014M4C2\u2014Inv. 1.1\u2014Cod. prog. 2022RY8549_002\u2014CUP J53D23003260006"]}],"id":[{"id":"10.13039\/501100000780","id-type":"DOI","asserted-by":"publisher"}]},{"award":["PRIN 2022\u2014D.D. 104\/2022\u2014DIKA EMI\u2014Fin. NextGenerationEU\u2014PNRR\u2014M4C2\u2014Inv. 1.1\u2014Cod. prog. 2022RY8549_002\u2014CUP J53D23003260006"],"award-info":[{"award-number":["PRIN 2022\u2014D.D. 104\/2022\u2014DIKA EMI\u2014Fin. NextGenerationEU\u2014PNRR\u2014M4C2\u2014Inv. 1.1\u2014Cod. prog. 2022RY8549_002\u2014CUP J53D23003260006"]}],"id":[{"id":"https:\/\/ror.org\/019w4f821","id-type":"ROR","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Cancers"],"abstract":"<jats:p>Background: Nevus-associated melanomas (NAM) are frequently diagnosed at an early stage, yet risk heterogeneity within thin tumors remains poorly characterized. Whether classical histopathologic features can refine risk stratification in this subgroup is unclear. Objective: To evaluate the prognostic significance of histopathologic features, particularly mitotic activity and tumor-infiltrating lymphocytes (TILs), in thin nevus-associated melanoma (pTis\u2013pT1a) (&lt;0.8 mm). Methods: Retrospective cohort study of 138 consecutive patients with histologically confirmed NAM diagnosed at a tertiary dermatologic oncology center (October 2006\u2013December 2023). Staging was reassessed as per AJCC 8th edition. A predefined subgroup analysis of 100 patients with thin NAM (pTis\u2013pT1a) evaluated adverse outcomes (distant metastasis or death) within 10 years. Associations were assessed using \u03c72 tests and logistic regression. Results: Median age was 53.5 years (IQR 44.0\u201363.8); 60.9% were male. Median Breslow thickness was 0.57 mm (IQR 0.4\u20130.8). Overall survival was 90.9% at 5 years and 86.0% at 10 years. Among thin NAM, eight patients (8%) experienced adverse outcomes. Mitotic activity \u2265 1\/mm2 was associated with higher adverse event rates (10.9% vs. 2.8%; OR, 4.30; 95% CI, 0.51\u201336.43; p = 0.18). A gradient was observed across TIL categories: adverse events occurred in 13.8% with absent TILs, 7.3% with non-brisk, and 0% with brisk TILs (p = 0.24). Exploratory multivariable analysis showed consistent effect directions without reaching statistical significance. Conclusions: Thin nevus-associated melanomas are not uniformly low risk. Mitotic activity and absent TILs were associated with higher adverse event rates, suggesting that classical histopathologic features may refine risk stratification in early-stage NAM.<\/jats:p>","DOI":"10.3390\/cancers18152456","type":"journal-article","created":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T11:38:54Z","timestamp":1785411534000},"page":"2456","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Thin Nevus-Associated Melanoma: Beyond MIA Score Risk Stratification"],"prefix":"10.3390","volume":"18","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5053-4172","authenticated-orcid":false,"given":"Federico","family":"Venturi","sequence":"first","affiliation":[{"name":"Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum University of Bologna, 40138 Bologna, Italy"},{"name":"Oncologic Dermatology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria Luisa","family":"Orlando","sequence":"additional","affiliation":[{"name":"Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum University of Bologna, 40138 Bologna, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6555-6227","authenticated-orcid":false,"given":"Barbara","family":"Corti","sequence":"additional","affiliation":[{"name":"Pathology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1309-2819","authenticated-orcid":false,"given":"Paola Valeria","family":"Marchese","sequence":"additional","affiliation":[{"name":"Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum University of Bologna, 40138 Bologna, Italy"},{"name":"Division of Medical Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francesca","family":"Comito","sequence":"additional","affiliation":[{"name":"Division of Medical Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Barbara","family":"Melotti","sequence":"additional","affiliation":[{"name":"Division of Medical Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3263-4353","authenticated-orcid":false,"given":"Elisabetta","family":"Magnaterra","sequence":"additional","affiliation":[{"name":"Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum University of Bologna, 40138 Bologna, Italy"},{"name":"Oncologic Dermatology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Biagio","family":"Scotti","sequence":"additional","affiliation":[{"name":"Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum University of Bologna, 40138 Bologna, Italy"},{"name":"Oncologic Dermatology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aurora Maria","family":"Alessandrini","sequence":"additional","affiliation":[{"name":"Oncologic Dermatology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Leonardo","family":"Veneziano","sequence":"additional","affiliation":[{"name":"Oncologic Dermatology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elena Maria","family":"Cama","sequence":"additional","affiliation":[{"name":"Oncologic Dermatology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3186-2861","authenticated-orcid":false,"given":"Emi","family":"Dika","sequence":"additional","affiliation":[{"name":"Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum University of Bologna, 40138 Bologna, Italy"},{"name":"Oncologic Dermatology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,7,30]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"938","DOI":"10.1016\/j.jaad.2017.06.149","article-title":"A meta-analysis of nevus-associated melanoma: Prevalence and practical implications","volume":"77","author":"Pampena","year":"2017","journal-title":"J. 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