Low UV radiation exposure/CSD | High UV radiation exposure/CSD | Low to no (or variable/incidental) UV radiation exposure/CSD | |||||||||
Pathway | I | II | III | IV | V | VI | VII | VIII | |||
Endpoint of pathway | Low-CSD melanoma/SSM | High-CSD melanoma/LMM | Desmoplastic melanoma | Malignant Spitz tumor/Spitz melanoma | Acral melanoma | Mucosal melanoma | Melanoma in congenital nevus | Melanoma in blue nevus | |||
Benign neoplasms (nevi) | Nevus | ? IMP | ? IMP | Spitz nevus | ? Acral nevus | ? Melanosis | Congenital nevus | Blue nevus | |||
Intermediate/low-grade dysplasias and melanocytomas | Low-grade dysplasia | BAP1-inactivated nevus | Deep penetrating nevus | ? IAMP/dysplasia | ? IAMP/dysplasia | Atypical Spitz tumor (melanocytoma) | IAMP/ dysplasia | Atypical melanosis/dysplasia/IAMPUS | Nodule in congenital nevus (melanocytoma) | (Atypical) cellular blue nevus (melanocytoma) | |
Intermediate/high-grade dysplasias and melanocytomas | High-grade dysplasia/MIS | BAP1-inactivated melanocytoma/MELTUMP | Deep penetrating melanocytoma/MELTUMP | Pigmented epithelioid melanocytoma/MELTUMP | Lentigo maligna (MIS) | MIS | STUMP/MELTUMP | Acral MIS | Mucosal MIS | MIS in congenital nevus | Atypical cellular blue nevus |
Malignant neoplasms | Low-CSD melanoma/SSM (VGP) | Melanoma in BAP1-inactivated nevus (rare) | Melanoma in deep penetrating nevus (rare) | Melanoma in pigmented epithelioid melanocytoma (rare) | LMM (VGP) | Desmoplastic melanoma | Malignant Spitz tumor/Spitz melanoma (tumorigenic) | Acral melanoma (VGP) | Mucosal lentiginous melanoma (VGP) | Melanoma in congenital nevus (tumorigenic) | Melanoma in blue nevus (tumorigenic) |
Common mutations* | BRAFV600E¶ or NRAS¶ | BRAF¶ or NRAS¶ plus BAP1Δ | BRAF¶, MAP2K1¶, or NRAS¶ plus CTNNB1¶ or APCΔ | BRAF¶ plus PRKAR1AΔ; or PRKCA¶ | NRAS¶; BRAF (non-V600E)¶; KIT¶; or NF1Δ | NF1Δ; ERBB2◊; MAP2K1◊; MAP3K1◊; BRAF◊; EGFR◊; MET◊ | HRAS¶; ALK§; ROS1§; RET§; NTRK1§; NTRK3§; BRAF§; or MET§ | KIT¶; NRAS¶; BRAF¶; HRAS¶; KRAS¶; NTRK3§; ALK§; or NF1Δ | KIT¶, NRAS¶, KRAS¶; or BRAF¶ | NRAS¶; BRAFV600E¶ (small lesions); or BRAF§ | GNAQ¶; GNA11¶; or CYSLTR2¶ |
TERT‡; CDKN2AΔ; TP53Δ; PTENΔ | TERT‡; CDKN2AΔ; TP53Δ; PTENΔ; RAC1¶ | TERT‡; NFKBIE‡; NRAS¶; PIK3CA¶; PTPN11¶ | CDKN2AΔ | CDKN2AΔ; TERT‡; CCND1◊; GAB2◊ | NF1¶; CDKN2AΔ; SF3B1¥; CCND1◊; CDK4◊; MDM2◊ | BAP1Δ; EIF1AX¶; SF3B1¶ |
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