51
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The HAM10000 dataset, a large collection of multi-source dermatoscopic images of common pigmented skin lesions. Sci Data 2018; 5:180161. [PMID: 30106392 PMCID: PMC6091241 DOI: 10.1038/sdata.2018.161] [Citation(s) in RCA: 558] [Impact Index Per Article: 93.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2018] [Accepted: 06/26/2018] [Indexed: 01/09/2023] Open
Abstract
Training of neural networks for automated diagnosis of pigmented skin lesions is hampered by the small size and lack of diversity of available datasets of dermatoscopic images. We tackle this problem by releasing the HAM10000 (“Human Against Machine with 10000 training images”) dataset. We collected dermatoscopic images from different populations acquired and stored by different modalities. Given this diversity we had to apply different acquisition and cleaning methods and developed semi-automatic workflows utilizing specifically trained neural networks. The final dataset consists of 10015 dermatoscopic images which are released as a training set for academic machine learning purposes and are publicly available through the ISIC archive. This benchmark dataset can be used for machine learning and for comparisons with human experts. Cases include a representative collection of all important diagnostic categories in the realm of pigmented lesions. More than 50% of lesions have been confirmed by pathology, while the ground truth for the rest of the cases was either follow-up, expert consensus, or confirmation by in-vivo confocal microscopy.
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52
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Costa-Silva M, Calistru A, Barros AM, Lopes S, Esteves M, Azevedo F. Dermatoscopy of flat pigmented facial lesions-evolution of lentigo maligna diagnostic criteria. Dermatol Pract Concept 2018; 8:198-203. [PMID: 30116664 PMCID: PMC6092074 DOI: 10.5826/dpc.0803a10] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2018] [Accepted: 04/14/2018] [Indexed: 11/10/2022] Open
Abstract
Recognition of facial lentigo maligna (LM) is often difficult, particularly at early stages. Algorithms and multivariate diagnostic models have recently been elaborated on the attempt to improve the diagnostic accuracy. We conducted a cross-sectional and retrospective study to evaluate dermatoscopic criteria aiding in diagnosis of flat pigmented facial lesions (FPFL). We examined 46 FPFL in 42 Caucasian patients and found that 4 of 20 dermatoscopic criteria reached the significance level required for features indicating malignancy namely, hyperpigmented follicular openings, obliterated follicular opening, annular-granular structures, and pigment rhomboids. Concomitant presence of at least 2 or 3 of the 4 mentioned criteria was significantly more frequent in LM than in pigmented actinic keratosis (PAK). However, despite more frequently seen in LM, these features were also displayed in some of the PAK and other FPFL, so we found them not specific for LM. Although dermatoscopy enhances the diagnostic accuracy in evaluating FPFL, histopathology remains the gold standard for correct diagnosis, making evident the need for improvements in early noninvasive diagnosis of LM.
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Affiliation(s)
- Miguel Costa-Silva
- Department of Dermatology and Venereology, Centro Hospitalar São João, EPE Porto, Portugal
| | - Ana Calistru
- Department of Dermatology and Venereology, Centro Hospitalar São João, EPE Porto, Portugal
| | - Ana Margarida Barros
- Department of Dermatology and Venereology, Centro Hospitalar São João, EPE Porto, Portugal
| | - Sofia Lopes
- Department of Dermatology and Venereology, Centro Hospitalar São João, EPE Porto, Portugal
| | - Mariana Esteves
- Department of Dermatology and Venereology, Centro Hospitalar São João, EPE Porto, Portugal
| | - Filomena Azevedo
- Department of Dermatology and Venereology, Centro Hospitalar São João, EPE Porto, Portugal
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53
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Beveridge J, Taher M, Zhu J, Mahmood MN, Salopek TG. Staged margin-controlled excision (SMEX) for lentigo maligna melanoma in situ. J Surg Oncol 2018; 118:144-149. [DOI: 10.1002/jso.25109] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2017] [Revised: 04/16/2018] [Accepted: 04/25/2018] [Indexed: 12/20/2022]
Affiliation(s)
- Julie Beveridge
- Division of Plastic Surgery; University of Alberta; Edmonton Alberta Canada
| | - Muba Taher
- Division of Dermatology, Department of Medicine; University of Alberta; Edmonton Alberta Canada
| | - Jay Zhu
- Division of Plastic Surgery; University of Alberta; Edmonton Alberta Canada
| | - Muhammad N. Mahmood
- Department of Laboratory Medicine and Pathology; University of Alberta; Edmonton Alberta Canada
| | - Thomas G. Salopek
- Division of Dermatology, Department of Medicine; University of Alberta; Edmonton Alberta Canada
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54
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Duarte AF, Sousa-Pinto B, Barros AM, Haneke E, Correia O. Lentigo Maligna - Not Always a Face and Neck Disease of the Elderly. Dermatology 2018; 234:37-42. [PMID: 29895005 DOI: 10.1159/000489397] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2018] [Accepted: 04/17/2018] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Lentigo maligna (LM) is a rare form of in situ melanoma, frequently seen as a large patch in elderly patients. The aim of this study was to assess clinical and dermoscopic features of LM. MATERIAL AND METHODS A retrospective study of LM patients presenting to our center between July 2007 and July 2017 was performed. Demographic data, anatomical location, laterality, diameter, Clark level, Breslow stage, "ABCD" signs and dermoscopic features were registered. Facial versus extrafacial LM were compared. RESULTS We found 21 LM, of which 12 had an extrafacial location and 9 a facial location. Half of the extrafacial lesions were located on an upper limb. The median age at diagnosis was 63 years (ranging from 38 to 84 years). Most LM cases were female (16/21) with phototype II (13/21). More than half of the patients (11/21) had a history of a skin neoplasm or actinic keratosis. The median diameter found was 6 mm (interquartile range = 4.5 mm), ranging from 1 to 15 mm. Five lesions were invasive (median Breslow depth of 0.2 mm), and 4 of them were extrafacial. DISCUSSION In this study LM was more frequently found in an extrafacial location and as a small patch with a 6-mm diameter medium. The epidemiology of LM/LM melanoma might be changing. Full body examination and dermoscopy are of the utmost importance for the diagnosis. Dermatologists should be aware and search for small lesions outside the face and neck, particularly in middle-aged female patients with photo-damaged skin.
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Affiliation(s)
- Ana Filipa Duarte
- Centro de Dermatologia Epidermis, Instituto CUF, Porto, Portugal.,MEDCIDS - Department of Community Medicine, Information and Health Decision Sciences, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Bernardo Sousa-Pinto
- MEDCIDS - Department of Community Medicine, Information and Health Decision Sciences, Faculty of Medicine, University of Porto, Porto, Portugal.,CINTESIS - Center for Health Technology and Services Research, University of Porto, Porto, Portugal.,Basic and Clinical Immunology Unit, Department of Pathology, Faculty of Medicine, University of Porto, Porto, Portugal
| | | | - Eckart Haneke
- Centro de Dermatologia Epidermis, Instituto CUF, Porto, Portugal.,Department of Dermatology, Inselspital, University of Bern, Bern, Switzerland.,Dermatology Clinic Dermaticum, Freiburg, Germany.,Department of Dermatology, University of Ghent, Ghent, Belgium
| | - Osvaldo Correia
- Centro de Dermatologia Epidermis, Instituto CUF, Porto, Portugal.,CINTESIS - Center for Health Technology and Services Research, University of Porto, Porto, Portugal.,Basic and Clinical Immunology Unit, Department of Pathology, Faculty of Medicine, University of Porto, Porto, Portugal
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55
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Zubair R, Haroon A, Rao B. Bedside diagnosis of lentigo maligna with reflectance confocal microscopy. J Cutan Pathol 2018; 45:553-555. [PMID: 29693252 DOI: 10.1111/cup.13264] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2018] [Revised: 04/13/2018] [Accepted: 04/19/2018] [Indexed: 11/29/2022]
Affiliation(s)
- Raheel Zubair
- Department of Dermatology, Rutgers Robert Wood Johnson Medical School, Somerset, New Jersey
| | - Attiya Haroon
- Department of Dermatology, Rutgers Robert Wood Johnson Medical School, Somerset, New Jersey
| | - Babar Rao
- Department of Dermatology, Rutgers Robert Wood Johnson Medical School, Somerset, New Jersey
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56
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De Luca EV, Perino F, Di Stefani A, Coco V, Fossati B, Peris K. Lentigo maligna: diagnosis and treatment. GIORN ITAL DERMAT V 2018; 155:179-189. [PMID: 29683288 DOI: 10.23736/s0392-0488.18.06003-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Lentigo maligna (LM) is an in situ subtype of melanoma, clinically presenting as a pigmented, asymmetric macule that originates mostly on the head and neck and spreads slowly. The diagnosis may be challenging both for clinicians and pathologists. Dermatoscopy and reflectance confocal microscopy represent a useful tool in the differentiation of LM from other pigmented lesions, such as pigmented actinic keratosis, solar lentigines, seborrheic keratosis and lichen planus-like keratosis. Moreover, those non-invasive diagnostic technique may be crucial in the selection of optimal biopsy sites in equivocal lesions, in pre-surgical mapping and in evaluating and monitoring response to non-surgical treatments. Histologic examination remains the gold standard for the diagnosis of LM, showing a lentiginous proliferation of basal atypical melanocytes on a severe sun-damaged skin. The management of LM is constantly evolving. Treatments include surgery (the first choice, when available), radiotherapy and imiquimod cream (in patients not candidates to surgery). Many other possible treatments for LM have been tested, but they are not yet supported by strong evidences. We collected current guidelines and PubMed available reviews, studies and case-reports in order to make an overview on diagnosis and treatment of LM.
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Affiliation(s)
- Erika V De Luca
- Institute of Dermatology, A. Gemelli University Polyclinic, IRCCS and Foundation, Sacred Heart Catholic University, Rome, Italy -
| | - Francesca Perino
- Institute of Dermatology, A. Gemelli University Polyclinic, IRCCS and Foundation, Sacred Heart Catholic University, Rome, Italy
| | - Alessandro Di Stefani
- Institute of Dermatology, A. Gemelli University Polyclinic, IRCCS and Foundation, Sacred Heart Catholic University, Rome, Italy
| | - Valeria Coco
- Institute of Dermatology, A. Gemelli University Polyclinic, IRCCS and Foundation, Sacred Heart Catholic University, Rome, Italy
| | - Barbara Fossati
- Institute of Dermatology, A. Gemelli University Polyclinic, IRCCS and Foundation, Sacred Heart Catholic University, Rome, Italy
| | - Ketty Peris
- Institute of Dermatology, A. Gemelli University Polyclinic, IRCCS and Foundation, Sacred Heart Catholic University, Rome, Italy
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57
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Russo T, Piccolo V, Ferrara G, Agozzino M, Alfano R, Longo C, Argenziano G. Dermoscopy pathology correlation in melanoma. J Dermatol 2018; 44:507-514. [PMID: 28447355 DOI: 10.1111/1346-8138.13629] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2016] [Accepted: 08/24/2016] [Indexed: 11/28/2022]
Abstract
Dermoscopy is a widely used technique whose role in the clinical (and preoperative) diagnosis of melanocytic and non-melanocytic skin lesions has been well established in recent years. The aim of this paper is to clarify the correlations between the "local" dermoscopic findings in melanoma and the underlying histology, in order to help clinicians in routine practice.
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Affiliation(s)
- Teresa Russo
- Dermatology Unit, Second University of Naples, Naples, Italy
| | | | - Gerardo Ferrara
- Department of Oncology, Anatomical Pathology Unit, Gaetano Rummo General Hospital, Benevento, Italy
| | - Marina Agozzino
- Dermatology Unit, Second University of Naples, Naples, Italy
| | - Roberto Alfano
- Department of Anesthesiology, Surgery and Emergency, Second University of Naples, Naples, Italy
| | - Caterina Longo
- Skin Cancer Unit, Arcispedale Santa Maria Nuova IRCCS, Reggio Emilia, Italy
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58
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Cinotti E, Labeille B, Debarbieux S, Carrera C, Lacarrubba F, Witkowski A, Moscarella E, Arzberger E, Kittler H, Bahadoran P, Gonzalez S, Guitera P, Agozzino M, Farnetani F, Hofmann-Wellenhof R, Ardigò M, Rubegni P, Tognetti L, Łudzik J, Zalaudek I, Argenziano G, Longo C, Ribero S, Malvehy J, Pellacani G, Cambazard F, Perrot J. Dermoscopy vs. reflectance confocal microscopy for the diagnosis of lentigo maligna. J Eur Acad Dermatol Venereol 2018; 32:1284-1291. [DOI: 10.1111/jdv.14791] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2017] [Accepted: 12/19/2017] [Indexed: 11/30/2022]
Affiliation(s)
- E. Cinotti
- Department of Dermatology; University Hospital of St-Etienne; Saint-Etienne France
- Department of Medical; Surgical and Neurological Science; Dermatology Section; University of Siena; S. Maria alle Scotte Hospital; Siena Italy
| | - B. Labeille
- Department of Dermatology; University Hospital of St-Etienne; Saint-Etienne France
| | - S. Debarbieux
- Departments of Dermatology; Centre Hospitalier Lyon Sud; Pierre Benite France
| | - C. Carrera
- Melanoma Unit; Department of Dermatology; Hospital Clínic de Barcelona; IDIBAPS; Barcelona University; Barcelona Spain
| | - F. Lacarrubba
- Dermatology Clinic; University of Catania; Catania Italy
| | - A.M. Witkowski
- Department of Dermatology; University of Modena and Reggio Emilia; Modena Italy
| | - E. Moscarella
- Dermatology Unit; Second University of Naples; Nuovo Policlinico; Naples Italy
| | - E. Arzberger
- Department of Dermatology and Venerology; Medical University of Graz; Graz Austria
| | - H. Kittler
- Department of Dermatology; Medical University of Vienna; Vienna Austria
| | - P. Bahadoran
- Department of Dermatology; Clinical Research Center; Hopital Archet 2; Nice France
| | - S. Gonzalez
- Medicine and Medical Specialities Department; Madrid and Dermatology Department; Alcalá University; Memorial Sloan-Kettering Cancer Center; New York NY USA
| | - P. Guitera
- Department of Dermatology; The University of Sydney; Sydney Melanoma Diagnostic Centre and Melanoma Institute Australia; Sydney NSW Australia
| | - M. Agozzino
- Dermatology Unit; Second University of Naples; Nuovo Policlinico; Naples Italy
| | - F. Farnetani
- Department of Dermatology; University of Modena and Reggio Emilia; Modena Italy
| | - R. Hofmann-Wellenhof
- Department of Dermatology and Venerology; Medical University of Graz; Graz Austria
| | - M. Ardigò
- Clinical Dermatology; San Gallicano Dermatological Institute; Rome Italy
| | - P. Rubegni
- Department of Medical; Surgical and Neurological Science; Dermatology Section; University of Siena; S. Maria alle Scotte Hospital; Siena Italy
| | - L. Tognetti
- Department of Medical; Surgical and Neurological Science; Dermatology Section; University of Siena; S. Maria alle Scotte Hospital; Siena Italy
- Department of Medical Biotechnologies; University of Siena; Siena Italy
| | - J. Łudzik
- Department of Bioinformatics and Telemedicine; Jagiellonian University Medical College; Krakow Poland
| | - I. Zalaudek
- Department of Dermatology and Venerology; Medical University of Graz; Graz Austria
| | - G. Argenziano
- Dermatology Unit; Second University of Naples; Nuovo Policlinico; Naples Italy
| | - C. Longo
- Dermatology and Skin Cancer Unit; Arcispedale Santa Maria Nuova-IRCCS; Reggio Emilia Italy
| | - S. Ribero
- Department of Medical Sciences; University of Turin; Turin Italy
| | - J. Malvehy
- Melanoma Unit; Department of Dermatology; Hospital Clínic de Barcelona; IDIBAPS; Barcelona University; Barcelona Spain
| | - G. Pellacani
- Department of Dermatology; University of Modena and Reggio Emilia; Modena Italy
| | - F. Cambazard
- Department of Dermatology; University Hospital of St-Etienne; Saint-Etienne France
| | - J.L. Perrot
- Department of Dermatology; University Hospital of St-Etienne; Saint-Etienne France
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59
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Casari A, Chester J, Pellacani G. Actinic Keratosis and Non-Invasive Diagnostic Techniques: An Update. Biomedicines 2018; 6:biomedicines6010008. [PMID: 29316678 PMCID: PMC5874665 DOI: 10.3390/biomedicines6010008] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2017] [Revised: 11/26/2017] [Accepted: 12/19/2017] [Indexed: 12/15/2022] Open
Abstract
Actinic keratosis represents the earliest manifestation of non-melanoma skin cancer. Because of their risk of progression to invasive squamous cell carcinoma, an earlier diagnosis and treatment are mandatory. Their diagnosis sometimes could represent a challenge even for expert dermatologists. Dermoscopy, confocal laser microscopy and optical coherence tomography could help clinicians in diagnosis.
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Affiliation(s)
- Alice Casari
- Clinica Dermatologica, Policlinico di Modena, Via del Pozzo 70, 41124 Modena, Italy.
| | - Johanna Chester
- Clinica Dermatologica, Policlinico di Modena, Via del Pozzo 70, 41124 Modena, Italy.
| | - Giovanni Pellacani
- Clinica Dermatologica, Policlinico di Modena, Via del Pozzo 70, 41124 Modena, Italy.
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60
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Volpini BMF, Maia M, Agi J, Vital J, Lellis RF. Synchronous conjunctival melanoma and lentigo maligna melanoma. An Bras Dermatol 2017; 92:565-567. [PMID: 28954115 PMCID: PMC5595613 DOI: 10.1590/abd1806-4841.20176015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2016] [Accepted: 08/22/2016] [Indexed: 12/18/2022] Open
Abstract
Lentigo maligna has an extensive and neoplastic character. It typically
progresses slowly and may eventually develop into an invasive melanoma, which is
called lentigo maligna melanoma. Ocular melanoma is the second most common type
of melanoma. The uvea is the most common site of origin of ocular melanomas,
while conjunctival melanoma accounts for about 1-5% of cases. In this article,
we describe a rare case of synchronic conjunctival melanoma and lentigo maligna
on the face.
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Affiliation(s)
| | - Marcus Maia
- Dermatology Clinic in the Department of Medicine at Irmandade da Santa Casa de Misericórdia de São Paulo - São Paulo (SP), Brazil
| | - Jorge Agi
- Dermatology Clinic in the Department of Medicine at Irmandade da Santa Casa de Misericórdia de São Paulo - São Paulo (SP), Brazil
| | - José Vital
- Department of Ophthalmology in Irmandade da Santa Casa de Misericórdia de São Paulo - São Paulo (SP), Brazil
| | - Rute Facchini Lellis
- Division of Dermatopathology in the Anatomical Pathology Service at Irmandade da Santa Casa de Misericórdia de São Paulo - São Paulo (SP), Brazil
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61
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Menzer C, Stolz W, Nilles M, Toberer F, Fink C, Haenssle HA. [Dermoscopically conspiciuous pigmented lesion on the forehead of a young male patient]. Hautarzt 2017; 68:1028-1030. [PMID: 28983642 DOI: 10.1007/s00105-017-4059-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- C Menzer
- Universitätshautklinik Heidelberg, Ruprecht-Karls-Universität, Im Neuenheimer Feld 440, 69120, Heidelberg, Deutschland
| | - W Stolz
- Klinik Thalkirchner Straße, Städtisches Klinikum München, München, Deutschland
| | - M Nilles
- Universitätshautklinik Heidelberg, Ruprecht-Karls-Universität, Im Neuenheimer Feld 440, 69120, Heidelberg, Deutschland
| | - F Toberer
- Universitätshautklinik Heidelberg, Ruprecht-Karls-Universität, Im Neuenheimer Feld 440, 69120, Heidelberg, Deutschland
| | - C Fink
- Universitätshautklinik Heidelberg, Ruprecht-Karls-Universität, Im Neuenheimer Feld 440, 69120, Heidelberg, Deutschland
| | - H A Haenssle
- Universitätshautklinik Heidelberg, Ruprecht-Karls-Universität, Im Neuenheimer Feld 440, 69120, Heidelberg, Deutschland.
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62
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Wolner ZJ, Yélamos O, Liopyris K, Rogers T, Marchetti MA, Marghoob AA. Enhancing Skin Cancer Diagnosis with Dermoscopy. Dermatol Clin 2017; 35:417-437. [PMID: 28886798 DOI: 10.1016/j.det.2017.06.003] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Dermoscopy increases the sensitivity for skin cancer detection, decreases the number of benign lesions biopsied for each malignant diagnosis, and enables the diagnosis of thinner melanomas compared with naked eye examination. Multiple meta-analyses have identified that dermoscopy improves the diagnostic accuracy for melanoma when compared with naked eye examination. In addition, studies have established that dermoscopy can aid in the detection of keratinocyte carcinomas. Dermoscopy triage algorithms have been developed to help novices decide when a biopsy or a referral is most appropriate. In this article, the authors illustrate the dermoscopic features that assist in identifying melanoma and keratinocyte carcinomas.
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Affiliation(s)
- Zachary J Wolner
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, 16 East 60th Street, New York, NY 10022, USA
| | - Oriol Yélamos
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, 16 East 60th Street, New York, NY 10022, USA
| | - Konstantinos Liopyris
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, 16 East 60th Street, New York, NY 10022, USA
| | - Tova Rogers
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, 16 East 60th Street, New York, NY 10022, USA
| | - Michael A Marchetti
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, 16 East 60th Street, New York, NY 10022, USA
| | - Ashfaq A Marghoob
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, 16 East 60th Street, New York, NY 10022, USA.
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63
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Benati E, Longo C, Piana S, Moscarella E. Preliminary evaluation of reflectance confocal microscopy features of scalp melanoma. Australas J Dermatol 2017; 58:312-316. [PMID: 28752561 DOI: 10.1111/ajd.12690] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2017] [Accepted: 05/18/2017] [Indexed: 11/27/2022]
Affiliation(s)
- Elisa Benati
- Skin Cancer Unit, Arcispedale S. Maria Nuova, Reggio Emilia, Italy
| | - Caterina Longo
- Skin Cancer Unit, Arcispedale S. Maria Nuova, Reggio Emilia, Italy
| | - Simonetta Piana
- Pathology Unit, Arcispedale S. Maria Nuova, Reggio Emilia, Italy
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64
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Pampena R, Longo C. Can we improve melanoma detection methods? Melanoma Manag 2017; 4:139-142. [PMID: 30190916 DOI: 10.2217/mmt-2017-0009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2017] [Accepted: 04/13/2017] [Indexed: 11/21/2022] Open
Affiliation(s)
- Riccardo Pampena
- Dermatology & Skin Cancer Unit, First Medical Department, Arcispedale Santa Maria Nuova, IRCCS, Reggio Emilia, Italy.,Dermatology & Skin Cancer Unit, First Medical Department, Arcispedale Santa Maria Nuova, IRCCS, Reggio Emilia, Italy
| | - Caterina Longo
- Dermatology & Skin Cancer Unit, First Medical Department, Arcispedale Santa Maria Nuova, IRCCS, Reggio Emilia, Italy.,Dermatology Unit, University of Modena & Reggio Emilia, Modena, Italy.,Dermatology & Skin Cancer Unit, First Medical Department, Arcispedale Santa Maria Nuova, IRCCS, Reggio Emilia, Italy.,Dermatology Unit, University of Modena & Reggio Emilia, Modena, Italy
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65
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Carbone A, Ferrari A, Paolino G, Buccini P, De Simone P, Eibenschutz L, Piemonte P, Silipo V, Sperduti I, Catricalà C, Frascione P. Lentigo maligna of the face: A quantitative simple method to identify individual patient risk probability on dermoscopy. Australas J Dermatol 2017; 58:286-291. [PMID: 28589538 DOI: 10.1111/ajd.12595] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2016] [Accepted: 11/01/2016] [Indexed: 11/30/2022]
Abstract
BACKGROUND/OBJECTIVES The clinical and dermoscopic differential diagnosis of flat pigmented facial lesions represents a great challenge for the clinicians. Our aim was to report a quantitative method based on dermoscopic features to better classify pigmented facial lesions. METHODS This is a retrospective case-series study that analysed the dermoscopic features of 582 pigmented facial lesions. RESULTS The individual patient probability of lentigo maligna (LM) was predicted by a multivariate model, with an accuracy of 0.72. According to the odds ratio at the multivariate analysis, an individual scoring index was assigned to each criterion, and a value of 4.56 was identified as optimal cut-off point. Up to a score of 2.5, the probability that a lesion is an LM is 0. The probability increases from 10 to 50% for a score ranging between 4.5 and 6. It is about 90% for a score of 7. CONCLUSION The optimal cut-off point obtained and the curve that identifies the probability of a patient having a LM could improve the classification and the management strategies of equivocal pigmented facial lesions.
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Affiliation(s)
- Anna Carbone
- Department of Oncological and Preventative Dermatological, San Gallicano Dermatological Institute, IRCCS, Rome, Italy
| | - Angela Ferrari
- Department of Oncological and Preventative Dermatological, San Gallicano Dermatological Institute, IRCCS, Rome, Italy
| | - Giovanni Paolino
- Department of Dermatology, Clinica Dermatologica, La Sapienza University of Rome, Rome, Italy
| | - Pierluigi Buccini
- Department of Oncological and Preventative Dermatological, San Gallicano Dermatological Institute, IRCCS, Rome, Italy
| | - Paola De Simone
- Department of Oncological and Preventative Dermatological, San Gallicano Dermatological Institute, IRCCS, Rome, Italy
| | - Laura Eibenschutz
- Department of Oncological and Preventative Dermatological, San Gallicano Dermatological Institute, IRCCS, Rome, Italy
| | - Paolo Piemonte
- Department of Oncological and Preventative Dermatological, San Gallicano Dermatological Institute, IRCCS, Rome, Italy
| | - Vitaliano Silipo
- Department of Oncological and Preventative Dermatological, San Gallicano Dermatological Institute, IRCCS, Rome, Italy
| | - Isabella Sperduti
- Department of Biostatistics, Regina Elena National Cancer Institute, Rome, Italy
| | - Caterina Catricalà
- Department of Oncological and Preventative Dermatological, San Gallicano Dermatological Institute, IRCCS, Rome, Italy
| | - Pasquale Frascione
- Department of Oncological and Preventative Dermatological, San Gallicano Dermatological Institute, IRCCS, Rome, Italy
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Lentigo Maligna, Macules of the Face, and Lesions on Sun-Damaged Skin: Confocal Makes the Difference. Dermatol Clin 2017; 34:421-429. [PMID: 27692448 DOI: 10.1016/j.det.2016.05.005] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Distinguishing lentigo maligna (LM) and lentigo maligna melanoma (LMM) from background pigmented non-melanoma lesions is challenging. The field of solar damage can obscure clinical assessment, and diagnostic ambiguities are created due to the overlap of the clinical features of LM with other benign lesions. Moreover, margin assessment on histology is limited by the resemblance between melanocytic hyperplasia of actinically damaged skin and scattered atypical melanocytes of LM/LMM. Dermoscopy has made a significant contribution but is often not sufficient for diagnosis and margin assessment. Confocal microscopy has become an important complementary tool in enhancing the management of these complex lesions.
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67
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Annessi G, Bono R, Abeni D. Correlation between digital epiluminescence microscopy parameters and histopathological changes in lentigo maligna and solar lentigo: A dermoscopic index for the diagnosis of lentigo maligna. J Am Acad Dermatol 2017; 76:234-243. [DOI: 10.1016/j.jaad.2016.08.032] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2016] [Revised: 08/16/2016] [Accepted: 08/16/2016] [Indexed: 11/28/2022]
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Gamo R, Pampín A, Floristán U. Reflectance Confocal Microscopy in Lentigo Maligna. ACTAS DERMO-SIFILIOGRAFICAS 2016. [DOI: 10.1016/j.adengl.2016.09.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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69
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Martínez-Leboráns L, Garcías-Ladaria J, Oliver-Martínez V, Miquel VAD. Extrafacial Lentigo Maligna: A Report on 14 Cases and a Review of the Literature. ACTA ACUST UNITED AC 2016. [DOI: 10.1016/j.adengl.2016.07.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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70
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Gamo R, Pampín A, Floristán U. Reflectance Confocal Microscopy in Lentigo Maligna. ACTAS DERMO-SIFILIOGRAFICAS 2016; 107:830-835. [PMID: 27614735 DOI: 10.1016/j.ad.2016.07.012] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2016] [Revised: 07/14/2016] [Accepted: 07/21/2016] [Indexed: 11/25/2022] Open
Abstract
Lentigo maligna is the most common type of facial melanoma. Diagnosis is complicated, however, as it shares clinical and dermoscopic characteristics with other cutaneous lesions of the face. Reflectance confocal microscopy is an imaging technique that permits the visualization of characteristic features of lentigo maligna. These include a disrupted honeycomb pattern and pagetoid cells with a tendency to show folliculotropism. These cells typically have a dendritic morphology, although they may also appear as round cells measuring over 20μm with atypical nuclei. Poorly defined dermal papillae and atypical cells may be seen at the dermal-epidermal junction and can form bridges resembling mitochondrial structures. Other characteristic findings include junctional swelling with atypical cells located around the follicles, resembling caput medusae. Reflectance confocal microscopy is a very useful tool for diagnosing lentigo maligna.
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Affiliation(s)
- R Gamo
- Hospital Universitario Fundación de Alcorcón, Madrid, España.
| | - A Pampín
- Hospital Universitario Fundación de Alcorcón, Madrid, España
| | - U Floristán
- Hospital Universitario Fundación de Alcorcón, Madrid, España
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71
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Papageorgiou C, Ioannides D, Apalla Z, Vakirlis E, Lazaridou E, Sotiriou E, Lallas A. Dermoscopy of difficult-to-diagnose Melanomas. SERBIAN JOURNAL OF DERMATOLOGY AND VENEREOLOGY 2016. [DOI: 10.1515/sjdv-2016-0011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
Dermoscopy is a non-invasive procedure that allows the evaluation of cutaneous lesions, and is considered to be a useful tool that improves the diagnostic accuracy of melanoma. Many dermoscopic criteria of melanoma have been established and several algorithms have been created for melanoma detection. However, the recognition of some melanomas remains challenging. Melanomas on specific body sites, melanomas in patients with multiple atypical moles, and nodular melanomas represent the most difficult-to-recognize melanoma subtypes, since they typically lack the “classic” melanoma-specific criteria. This paper provides an update on dermoscopy of difficult-to-diagnose melanomas by summarizing the newest data. Lastly, we highlight the importance of digital dermoscopy in the follow-up of melanocytic lesions for the detection of incipient melanomas while maintaining a low excision rate.
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Affiliation(s)
| | | | - Zoe Apalla
- First Department of Dermatology, Aristotle University, Thessaloniki, Greece
| | | | | | - Eleni Sotiriou
- First Department of Dermatology, Aristotle University, Thessaloniki, Greece
| | - Aimilios Lallas
- First Department of Dermatology, Aristotle University, Thessaloniki, Greece
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Peris K, Maiorino A, Di Stefani A, Longo C, Piana S, Argenziano G. Brown globules in lentigo maligna (LM): A useful dermoscopic clue. J Am Acad Dermatol 2016; 75:429-30. [DOI: 10.1016/j.jaad.2016.02.1231] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2016] [Revised: 02/24/2016] [Accepted: 02/25/2016] [Indexed: 11/17/2022]
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Garbe C, Peris K, Hauschild A, Saiag P, Middleton M, Bastholt L, Grob JJ, Malvehy J, Newton-Bishop J, Stratigos AJ, Pehamberger H, Eggermont AM. Diagnosis and treatment of melanoma. European consensus-based interdisciplinary guideline - Update 2016. Eur J Cancer 2016; 63:201-17. [PMID: 27367293 DOI: 10.1016/j.ejca.2016.05.005] [Citation(s) in RCA: 273] [Impact Index Per Article: 34.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2016] [Accepted: 05/16/2016] [Indexed: 01/12/2023]
Abstract
Cutaneous melanoma (CM) is potentially the most dangerous form of skin tumour and causes 90% of skin cancer mortality. A unique collaboration of multi-disciplinary experts from the European Dermatology Forum, the European Association of Dermato-Oncology and the European Organisation of Research and Treatment of Cancer was formed to make recommendations on CM diagnosis and treatment, based on systematic literature reviews and the experts' experience. Diagnosis is made clinically using dermoscopy and staging is based upon the AJCC system. CMs are excised with 1-2 cm safety margins. Sentinel lymph node dissection is routinely offered as a staging procedure in patients with tumours >1 mm in thickness, although there is as yet no clear survival benefit for this approach. Interferon-α treatment may be offered to patients with stage II and III melanoma as an adjuvant therapy, as this treatment increases at least the disease-free survival and less clear the overall survival (OS) time. The treatment is however associated with significant toxicity. In distant metastasis, all options of surgical therapy have to be considered thoroughly. In the absence of surgical options, systemic treatment is indicated. For first-line treatment particularly in BRAF wild-type patients, immunotherapy with PD-1 antibodies alone or in combination with CTLA-4 antibodies should be considered. BRAF inhibitors like dabrafenib and vemurafenib in combination with the MEK inhibitors trametinib and cobimetinib for BRAF mutated patients should be offered as first or second line treatment. Therapeutic decisions in stage IV patients should be primarily made by an interdisciplinary oncology team ('Tumour Board').
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Affiliation(s)
- Claus Garbe
- Centre for Dermatooncology, Department of Dermatology, Eberhard Karls University, Tuebingen, Germany.
| | - Ketty Peris
- Institute of Dermatology, Catholic University, Rome, Italy
| | - Axel Hauschild
- Department of Dermatology, University Hospital Schleswig-Holstein (UKSH), Campus Kiel, Kiel, Germany
| | - Philippe Saiag
- University Department of Dermatology, Université de Versailles-Saint Quentin en Yvelines, APHP, Boulogne, France
| | - Mark Middleton
- NIHR Biomedical Research Centre, University of Oxford, UK
| | - Lars Bastholt
- Department of Oncology, Odense University Hospital, Denmark
| | | | - Josep Malvehy
- Melanoma Unit, Department of Dermatology, Hospital Clinic, IDIBAPS, Barcelona, Spain
| | - Julia Newton-Bishop
- Section of Biostatistics and Epidemiology, Leeds Institute of Cancer and Pathology, University of Leeds, UK
| | - Alexander J Stratigos
- 1(st) Department of Dermatology, University of Athens School of Medicine, Andreas Sygros Hospital, Athens, Greece
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Lentigo maligno. Claves en el diagnóstico dermatoscópico. ACTAS DERMO-SIFILIOGRAFICAS 2016; 107:489-97. [DOI: 10.1016/j.ad.2016.01.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2015] [Revised: 12/15/2015] [Accepted: 01/03/2016] [Indexed: 11/20/2022] Open
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Bollea-Garlatti L, Galimberti G, Galimberti R. Lentigo Maligna: Keys to Dermoscopic Diagnosis. ACTAS DERMO-SIFILIOGRAFICAS 2016. [DOI: 10.1016/j.adengl.2016.05.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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76
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Martínez-Leboráns L, Garcías-Ladaria J, Oliver-Martínez V, Alegre de Miquel V. Extrafacial Lentigo Maligna: A Report on 14 Cases and a Review of the Literature. ACTAS DERMO-SIFILIOGRAFICAS 2016; 107:e57-63. [PMID: 27180003 DOI: 10.1016/j.ad.2015.10.018] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2015] [Revised: 08/17/2015] [Accepted: 10/18/2015] [Indexed: 11/27/2022] Open
Abstract
Lentigo maligna is the most common form of in situ melanoma. It is most often found on the head and neck, and its clinical and dermoscopic features in this location have been extensively described in the literature. We present a series of 14 patients diagnosed with extrafacial lentigo maligna and lentigo maligna melanoma at Hospital General de Valencia and Hospital de Manacor in Spain, and describe the clinical, dermoscopic, and histologic features observed. Most of the melanomas were located on the upper limbs; the next most common locations were the trunk and the lower limbs. The dermoscopic patterns were consistent with facial lentigo maligna and superficial spreading melanoma. Extrafacial lentigo maligna is uncommon. It has similar clinical and histologic features to facial lentigo, but dermoscopy may show a mix of patterns typically seen in lentigo maligna and superficial spreading melanoma. This difference in dermoscopic features is essentially due to anatomical differences between skin on the face and on other parts of the body.
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Affiliation(s)
- L Martínez-Leboráns
- Servicio de Dermatología, Hospital General Universitario de Valencia, Valencia, España.
| | - J Garcías-Ladaria
- Servicio de Dermatología, Hospital Manacor, Manacor, Mallorca, España
| | - V Oliver-Martínez
- Servicio de Dermatología, Hospital General Universitario de Valencia, Valencia, España
| | - V Alegre de Miquel
- Servicio de Dermatología, Hospital General Universitario de Valencia, Valencia, España; Universidad de Valencia, Valencia, España
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Cengiz FP, Cengiz AB, Emiroglu N, Comert E, Wellenhof RH. Dermoscopic and clinical features of head and neck melanoma. An Bras Dermatol 2016; 90:488-93. [PMID: 26375217 PMCID: PMC4560537 DOI: 10.1590/abd1806-4841.20153341] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND The dermoscopic criteria of extrafacial melanomas are well-known. OBJECTIVE To determine the frequency of dermatoscopic findings in head and neck melanomas (HNM) and to assess the distinguishing dermoscopic criteria of facial and extrafacial melanoma. METHODS This observational study included 108 patients with HNM (63% male, mean age 64 years). Participants underwent individual dermoscopic imaging of clinically melanoma. All lesions were excised, and histopathological examination was performed on all specimens. RESULTS Drawing on histopathological analysis, lentigo maligna melanoma or lentigo maligna was diagnosed in 60 lesions, superficial spreading melanoma in 18, nodular in 10, desmoplastic in 8, superficial spreading melanoma in situ in 12. The most frequent location for head and neck melanoma was the cheek (60 patients, 55.6%). Eight prominent dermatoscopic features were observed in facial melanoma: annular-granular pattern (18%); rhomboidal structures (29%); pseudonetwork (29%); asymmetrical, pigmented, follicular openings (51%); obliterated hair follicles (8%); red rhomboidal structures (18%); increased density of the vascular network (32%); scar-like depigmentation (59%). CONCLUSIONS HNM has specific dermoscopic features, and classical extrafacial dermoscopic rules are less useful for diagnosis of facial melanoma. In our study, further characteristic dermatoscopic findings were detected in facial melanoma such as low frequencies of irregular dots, 2 or fewer colors in lesions, the presence of pseudonetwork, increased density of the vascular network, red rhomboidal structures, in addition to dermatoscopic findings of extrafacial melanoma. Thus, it is concluded that the prediction and identification of HNM may be evident with the help of these signs.
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78
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Lallas A, Tschandl P, Kyrgidis A, Stolz W, Rabinovitz H, Cameron A, Gourhant J, Giacomel J, Kittler H, Muir J, Argenziano G, Hofmann-Wellenhof R, Zalaudek I. Dermoscopic clues to differentiate facial lentigo maligna from pigmented actinic keratosis. Br J Dermatol 2016; 174:1079-85. [DOI: 10.1111/bjd.14355] [Citation(s) in RCA: 50] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/26/2015] [Indexed: 11/26/2022]
Affiliation(s)
- A. Lallas
- Skin Cancer Unit; Arcispedale Santa Maria Nuova IRCCS; Viale Risorgimento 80 42100 Reggio Emilia Italy
| | - P. Tschandl
- Department of Dermatology; Medical University of Vienna; Vienna Austria
| | - A. Kyrgidis
- Skin Cancer Unit; Arcispedale Santa Maria Nuova IRCCS; Viale Risorgimento 80 42100 Reggio Emilia Italy
| | - W. Stolz
- Department of Dermatology, Allergology and Environmental Medicine II; Hospital Thalkirchner Straße; Städtisches Klinikum Munich Munich Germany
| | | | - A. Cameron
- School of Medicine; University of Queensland; Brisbane Qld Australia
| | | | - J. Giacomel
- Skin Spectrum Medical Services; Como WA Australia
| | - H. Kittler
- Department of Dermatology; Medical University of Vienna; Vienna Austria
| | - J. Muir
- School of Medicine; The University of Queensland; Brisbane Qld Australia
| | - G. Argenziano
- Dermatology Unit; Second University of Naples; Naples Italy
| | - R. Hofmann-Wellenhof
- Department of Dermatology and Venerology; Non-Melanoma Skin Cancer Unit; Medical University of Graz; Graz Austria
| | - I. Zalaudek
- Department of Dermatology and Venerology; Non-Melanoma Skin Cancer Unit; Medical University of Graz; Graz Austria
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79
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Kasprzak JM, Xu YG. Diagnosis and management of lentigo maligna: a review. Drugs Context 2015; 4:212281. [PMID: 26082796 PMCID: PMC4453766 DOI: 10.7573/dic.212281] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2015] [Accepted: 05/12/2015] [Indexed: 01/14/2023] Open
Abstract
Lentigo maligna is a melanocytic neoplasm occurring on sun-exposed skin, usually on the head and neck, of middle-aged and elderly patients. It is thought to represent the in situ phase of lentigo maligna melanoma. The ill-defined nature and potentially large size of lesions can pose significant diagnostic and treatment challenges. The goal of therapy is to cure the lesions in order to prevent development of invasive disease, and surgical excision is the treatment of choice to achieve clear histological margins. Nonsurgical treatment modalities have been reported; however, evidence is lacking to support their use. Age, general health, and comorbidities need to be taken into account when deciding the right treatment modality for each individual patient.
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Affiliation(s)
- Julia M Kasprzak
- Department of Dermatology, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Yaohui G Xu
- Department of Dermatology, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
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80
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Tiodorovic-Zivkovic D, Argenziano G, Lallas A, Thomas L, Ignjatovic A, Rabinovitz H, Moscarella E, Longo C, Hofmann-Wellenhof R, Zalaudek I. Age, gender, and topography influence the clinical and dermoscopic appearance of lentigo maligna. J Am Acad Dermatol 2015; 72:801-8. [DOI: 10.1016/j.jaad.2015.01.030] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2014] [Revised: 01/16/2015] [Accepted: 01/19/2015] [Indexed: 12/17/2022]
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81
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de Carvalho N, Farnetani F, Ciardo S, Ruini C, Witkowski AM, Longo C, Argenziano G, Pellacani G. Reflectance confocal microscopy correlates of dermoscopic patterns of facial lesions help to discriminate lentigo maligna from pigmented nonmelanocytic macules. Br J Dermatol 2015; 173:128-33. [PMID: 25413382 DOI: 10.1111/bjd.13546] [Citation(s) in RCA: 59] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/15/2014] [Indexed: 11/27/2022]
Abstract
BACKGROUND The clinical recognition of lentigo maligna (LM) and LM melanoma can be very challenging due to the overlapping features it shares with other pigmented macules of the skin. Noninvasive diagnostic techniques can assist in the differential diagnosis. OBJECTIVES To identify reflectance confocal microscopy (RCM) indicators for LM through the identification of in vivo microscopic substrates of the main dermoscopic features seen in flat pigmented lesions of the face. METHODS Retrospective analysis of 60 pigmented lesions (LM, invasive melanoma, solar lentigo/flat seborrhoeic keratosis, lichen planus-like keratosis, pigmented actinic keratosis) was carried out. The main dermoscopic patterns and RCM features were described. A new method for correlating RCM with dermoscopic patterns was developed. RESULTS Pseudonetwork (37 of 60 lesions) and annular granular structures (37 of 60 lesions) were the most frequent dermoscopic patterns, followed by pigmented blotches (27 of 60 lesions). Upon RCM examination, pseudonetwork and blotches differed in melanomas and other nonmelanocytic lesions. These differences included the intraepidermal proliferation of atypical cells (predominantly dendritic-shaped with adnexal tropism) and the presence of a meshwork pattern at the junction. Also, annular granular structures exhibited dendritic cells almost exclusively in melanoma, with no difference between melanomas and nonmelanocytic lesions for the junctional and upper dermal pattern (characterized by dermal inflammation). Fingerprinting was mostly present in nonmelanocytic lesions or corresponded to an overlap with solar lentigo in melanomas. CONCLUSIONS RCM is useful for identifying the histological substrate of dermoscopic features in pigmented lesions of the face. It can provide a better definition of the lesion areas, enabling an improved diagnostic approach.
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Affiliation(s)
- N de Carvalho
- Department of Dermatology, University of Modena and Reggio Emilia, Modena, Italy
| | - F Farnetani
- Department of Dermatology, University of Modena and Reggio Emilia, Modena, Italy
| | - S Ciardo
- Department of Dermatology, University of Modena and Reggio Emilia, Modena, Italy
| | - C Ruini
- Department of Dermatology, University of Modena and Reggio Emilia, Modena, Italy
| | - A M Witkowski
- Department of Dermatology, University of Modena and Reggio Emilia, Modena, Italy
| | - C Longo
- Dermatology and Skin Cancer Unit, Arcispedale Santa Maria Nuova, Istituto di Ricovero e Cura a Carattere Scientifico-IRCCS, Reggio Emilia, Italy
| | - G Argenziano
- Dermatology and Skin Cancer Unit, Arcispedale Santa Maria Nuova, Istituto di Ricovero e Cura a Carattere Scientifico-IRCCS, Reggio Emilia, Italy
| | - G Pellacani
- Department of Dermatology, University of Modena and Reggio Emilia, Modena, Italy
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82
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Jaimes N, Marghoob AA, Rabinovitz H, Braun RP, Cameron A, Rosendahl C, Canning G, Keir J. Clinical and dermoscopic characteristics of melanomas on nonfacial chronically sun-damaged skin. J Am Acad Dermatol 2015; 72:1027-35. [PMID: 25824275 DOI: 10.1016/j.jaad.2015.02.1117] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2014] [Revised: 01/24/2015] [Accepted: 02/16/2015] [Indexed: 11/29/2022]
Abstract
BACKGROUND Melanomas on chronically sun-damaged skin (CSDS) can be difficult to identify and often manifest morphologic features that overlap with benign lesions. OBJECTIVE We describe and analyze the clinical and dermoscopic characteristics of melanomas on nonfacial CSDS. METHODS Melanoma cases on nonfacial CSDS were retrospectively identified from the biopsy specimen logs of 6 melanoma clinics. Clinical and dermoscopic images were combined into 1 database. Demographics, clinical, dermoscopic, and histopathologic information were analyzed. Descriptive frequencies were calculated. RESULTS One hundred eighty-six cases met the inclusion criteria: 142 melanomas in situ (76%) and 39 invasive (21%; mean thickness, 0.49 mm). Lentigo maligna was the most common histopathologic subtype (n = 76; 40.9%). The most frequent dermoscopic structures were granularity (n = 126; 67.7%) and angulated lines (n = 82; 44%). Vascular structures were more frequent in invasive melanomas (56% vs 12% of in situ melanomas). Most manifested 1 of 3 dermoscopic patterns: patchy peripheral pigmented islands, angulated lines, and tan structureless with granularity pattern. LIMITATIONS This was a retrospective study, and evaluators were not blinded to the diagnosis. In addition, interobserver concordance and sensitivity and specificity for dermoscopic structures were not evaluated. CONCLUSION Outlier lesions manifesting dermoscopic structures, such as granularity, angulated lines, or vessels and any of the 3 described dermoscopic patterns should raise suspicion for melanoma.
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Affiliation(s)
- Natalia Jaimes
- Dermatology Service, Aurora Skin Cancer Center and Universidad Pontificia Bolivariana, Medellín, Colombia
| | - Ashfaq A Marghoob
- Dermatology Service, Memorial Sloan-Kettering Cancer Center, New York, New York
| | | | - Ralph P Braun
- Department of Dermatology, University Hospital Zürich, Zürich, Switzerland
| | - Alan Cameron
- School of Medicine, The University of Queensland, Brisbane, Australia
| | - Cliff Rosendahl
- School of Medicine, The University of Queensland, Brisbane, Australia
| | - Greg Canning
- Hermit Park Clinic and Skin Cancer Care, Townsville, Australia
| | - Jeffrey Keir
- Northern Rivers Skin Cancer Clinic, Ballina, Australia.
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Tzellos T, Kyrgidis A, Mocellin S, Chan AW, Pilati P, Apalla Z. Interventions for melanoma in situ, including lentigo maligna. Cochrane Database Syst Rev 2014; 2014:CD010308. [PMID: 25526608 PMCID: PMC11005944 DOI: 10.1002/14651858.cd010308.pub2] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
BACKGROUND Malignant melanoma is a form of skin cancer associated with significant mortality once it has spread beyond the skin. Melanoma in situ (MIS) is the earliest histologically recognisable stage of malignant melanoma and represents a precursor of invasive melanoma. Lentigo maligna (LM) represents a subtype of pre-invasive intraepidermal melanoma associated specifically with chronic exposure to ultraviolet (UV) radiation. Over the past two decades, the incidence of MIS has increased significantly, even more than the invasive counterpart. There are several treatment options for MIS, but no consensus exists on the best therapeutic management of this condition. OBJECTIVES To assess the effects of all available interventions, surgical and non-surgical, for the treatment of melanoma in situ, including LM. SEARCH METHODS We searched the following databases up to November 2014: the Cochrane Skin Group Specialised Register, CENTRAL in The Cochrane Library (2014, Issue 10), MEDLINE (from 1946), Embase (from 1974), LILACS (from 1982), African Index Medicus (from inception), IndeMED of India (from inception), and Index Medicus for the South-East Asia Region (IMSEAR) (from inception). We scanned the references of included and excluded studies for further references to relevant trials and searched five trials registries. We checked the abstracts of major dermatology and oncology conference proceedings, and we shared our lists of included and excluded studies with industry contacts and other experts in the field of melanoma to try to identify further relevant trials. SELECTION CRITERIA We included randomised controlled trials (RCT) on the management of MIS, including LM, that compared any intervention to placebo or active treatment. We included individuals, irrespective of age and sex, diagnosed with MIS, including LM, based on histological examination. DATA COLLECTION AND ANALYSIS Two authors independently evaluated possible studies for inclusion; extracted data from the included study using a standard data extraction form modified for our review; assessed risk of bias; and analysed data on efficacy, safety, and tolerability. They resolved any disagreements by discussion with a third author. We collected adverse effects information from included studies. MAIN RESULTS Our search identified only 1 study eligible for inclusion (and 1 ongoing study in active recruitment stage), which was a single centre, open label, parallel group, 2-arm RCT with 90 participants, who had 91 histologically proven LM lesions.Forty-four participants, with 44 LM lesions, were treated with imiquimod 5% cream 5 days per week plus tazarotene 0.1% gel 2 days/week for 3 months, and 46 participants, with 47 LM lesions, were treated with imiquimod 5% cream 5 days per week for 3 months. Two months after cessation of topical treatment, the initial tumour footprint was excised using 2 mm margins via a staged excision. This study was open label, and analysis was not intention-to-treat, leading to a high risk of incomplete outcome data.Our primary outcome 'Histological or clinical complete response' was measured at 5 months in 29/44 participants (66%) treated with imiquimod plus tazarotene (combination therapy) and 27/46 participants (59%) treated with imiquimod (monotherapy). The difference was not statistically significant (risk ratio (RR) 1.12, 95% confidence interval (CI) 0.81 to 1.55, P value = 0.48).With regard to our secondary outcomes on recurrence and inflammation, after a mean follow up of 42 months, no local recurrences were observed among complete responders. Difference in overall inflammation score between the 2 groups was significant (mean difference (MD) 0.6, 95% CI 0.2 to 1, P value = 0.004), with the mean overall inflammation score being significantly higher in the combination group.The study authors did not clearly report on side-effects. Because of adverse effects, there was a dropout rate of 6/44 participants (13.7%) in the combination group compared with 1/46 (2.2%) in the imiquimod monotherapy group (due to excessive inflammation) before the cessation of topical treatment (first 3 months), but this was not statistically significant (RR 6.27, 95% CI 0.79 to 50.02, P value = 0.08). AUTHORS' CONCLUSIONS There is a lack of high-quality evidence for the treatment of MIS and LM.For the treatment of MIS, we found no RCTs of surgical interventions aiming to optimise margin control (square method, perimeter technique, 'slow Mohs', staged radial sections, staged "mapped" excisions, or Mohs micrographic surgery), which are the most widely used interventions recommended as first-line therapy. The use of non-surgical interventions in selected cases (patients with contraindications to surgical interventions) may be effective and may be considered preferable for experienced providers and under close and adequate follow up.For the treatment of LM, we found no RCTs of surgical interventions, which remain the most widely used and recommended available treatment. The use of non-surgical interventions, such as imiquimod, as monotherapy may be effective and may be considered in selected cases where surgical procedures are contraindicated and used preferentially by experienced providers under close and adequate follow up. The use of topical therapies, such as 5-fluorouracil and imiquimod, as neoadjuvant therapies warrants further investigation. There is insufficient evidence to support or refute the addition of tazarotene to imiquimod as adjuvant therapy; the current evidence suggests that it can increase topical inflammatory response and withdrawal of participants because of treatment-related side-effects.
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Affiliation(s)
- Thrasivoulos Tzellos
- Department of Dermatology, Faculty of Health Sciences, University Hospital of North Norway, Harstad, Troms, Norway. .
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Richtig E, Arzberger E, Hofmann-Wellenhof R, Fink-Puches R. Assessment of changes in lentigo maligna during radiotherapy by in-vivo reflectance confocal microscopy: a pilot study. Br J Dermatol 2014; 172:81-7. [PMID: 24889911 DOI: 10.1111/bjd.13141] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/15/2014] [Indexed: 11/29/2022]
Abstract
BACKGROUND Radiotherapy is an effective treatment for therapy of lentigo maligna (LM). OBJECTIVES To investigate the usefulness of in-vivo reflectance confocal microscopy (RCM) in radiotherapy of LM and document the changes within the lesions during treatment. METHODS A total of six lesions in six patients were investigated by RCM before, during and after radiotherapy. For diagnostic assessment three observers with experience in RCM diagnosis, blinded as to the stage of treatment, assessed the RCM images of each lesion and documented the findings by consensus. RESULTS Epidermal disarray worsened in three patients during radiotherapy and superficial necrosis was observed in four patients. Large pagetoid round/dendritic cells decreased or even vanished during or after radiotherapy. Dilated vessels and apoptotic cells were seen in all patients during radiotherapy as well as an increase of inflammatory cells in the epidermis and dermis in most of the patients. Dendritic cells with small dendrites were observed during radiotherapy in all patients with an increase in number in three patients. Melanophages appeared in five patients at least once during the examination period. All RCM images were assessed correctly by the three observers. CONCLUSIONS Reflectance confocal microscopy is a useful method to visualize changes during and after radiotherapy and might also be used for early detection of potential treatment failures. In addition, it might be helpful in planning radiotherapy.
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Affiliation(s)
- E Richtig
- Department of Dermatology, Medical University of Graz, Auenbruggerplatz 8, A-8036, Graz, Austria
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85
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Inner gray halo, a novel dermoscopic feature for the diagnosis of pigmented actinic keratosis: Clues for the differential diagnosis with lentigo maligna. J Am Acad Dermatol 2014; 71:708-15. [DOI: 10.1016/j.jaad.2014.05.025] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2014] [Revised: 04/19/2014] [Accepted: 05/08/2014] [Indexed: 11/24/2022]
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86
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Mendes MST, Costa MC, Gomes CM, de Araújo LC, Takano GHS. Amelanotic metastatic cutaneous melanoma. An Bras Dermatol 2014; 88:989-91. [PMID: 24474114 PMCID: PMC3900356 DOI: 10.1590/abd1806-4841.20132206] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2012] [Accepted: 10/25/2012] [Indexed: 11/22/2022] Open
Abstract
Dermatoscopy of melanocytic lesions has guided the decision of when or not to biopsy
a lesion. The use of this tool has increased clinical examination's sensitivity and
specificity in 89% and 96% respectively. However, dermatoscopic evaluation of
amelanotic or hypomelanotic melanomas, as well as metastases, can be difficult. There
is still no standardization for the analysis of these pathologies, which relies
mostly on their vascular pattern. We describe the dermatoscopy of acral metastatic
amelanotic melanoma.
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Affiliation(s)
- Marcela Sena Teixeira Mendes
- Dermatology service, Brasilia University Hospital, Brasilia University, BrasíliaDF, Brazil, MD, Resident of the Dermatology service at Brasilia University Hospital - Brasilia University (HUB-UnB) - Brasília (DF), Brazil
| | - Mariana Carvalho Costa
- Dermatology service, University Hospital Prof. Edgard Santos, Federal University the Bahia, SalvadorBA, Brazil, MD, Specialist in dermatology - Preceptor of the Dermatology service at University Hospital Prof. Edgard Santos at Federal University the Bahia (HUPESUFBA) - Salvador (BA), Brazil. Former-collaborating Dermatologist at the Dermatology Service at HUB/Unb - Brasília (DF), Brazil
| | - Ciro Martins Gomes
- Dermatology Service, Brasilia University Hospital, Brasilia University, BrasíliaDF, Brazil, MD, Specialist in dermatology - Preceptor of the Brasilia University Hospital Dermatology Service- Brasilia University (HUB-UnB) - Brasília (DF), Brazil
| | - Lisley Calixto de Araújo
- Dermatology service, Brasilia University Hospital, Brasilia University, BrasíliaDF, Brazil, MD, Resident of the Dermatology service at Brasilia University Hospital - Brasilia University (HUB-UnB) - Brasília (DF), Brazil
| | - Gustavo Henrique Soares Takano
- Brasilia University Hospital, Brasilia University, BrasíliaDF, Brazil, MD, Specialist in Pathology - Pathologist at Brasilia University Hospital - Brasilia University (HUB-UnB) - Brasília (DF), Brazil
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87
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Ciudad-Blanco C, Avilés-Izquierdo J, Lázaro-Ochaita P, Suárez-Fernández R. Dermoscopic Findings for the Early Detection of Melanoma: An Analysis of 200 Cases. ACTAS DERMO-SIFILIOGRAFICAS 2014. [DOI: 10.1016/j.adengl.2014.07.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Lallas A, Argenziano G, Moscarella E, Longo C, Simonetti V, Zalaudek I. Diagnosis and management of facial pigmented macules. Clin Dermatol 2014; 32:94-100. [PMID: 24314382 DOI: 10.1016/j.clindermatol.2013.05.030] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
The differential diagnosis of pigmented macules on the mottled chronic sun-damaged skin of the face is challenging and includes lentigo maligna (LM), pigmented actinic (solar) keratosis, solar lentigo, and lichen-planus-like keratosis. Although dermatoscopy improves the diagnostic accuracy of the unaided eye, the accurate diagnosis and management of pigmented facial macules remains one of the most challenging scenarios in daily practice. This is related to the fact that pigmented actinic (solar) keratosis, lichen-planus-like keratosis, and LM may reveal overlapping criteria, making their differential diagnosis clinically difficult. For this reason, practical rules have been introduced, which should help to minimize the risk for inappropriate diagnosis and management of LM.
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Affiliation(s)
- Aimilios Lallas
- Skin Cancer Unit, Arcispedale Santa Maria Nuova, Istituto di Ricovero e Cura a Carattere Scientifico, Viale Risorgimento 80, 42100 Reggio Emilia, Italy
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89
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Management of Lentigo Maligna: Update on Surgical and Medical Treatments. CURRENT DERMATOLOGY REPORTS 2014. [DOI: 10.1007/s13671-014-0072-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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90
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Guitera P, Haydu LE, Menzies SW, Scolyer RA, Hong A, Fogarty GB, Gallardo F, Segura S. Surveillance for treatment failure of lentigo maligna with dermoscopy and in vivo confocal microscopy: new descriptors. Br J Dermatol 2014; 170:1305-12. [PMID: 24641247 DOI: 10.1111/bjd.12839] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/10/2014] [Indexed: 11/28/2022]
Abstract
BACKGROUND Nonsurgical treatment (radiotherapy, imiquimod) is increasingly employed for the management of lentigo maligna (LM). While the diagnosis of LM remains difficult, the detection of treatment failure is even more challenging. OBJECTIVES To describe the sensitivity and specificity for the diagnosis of LM of individual features and methods using dermoscopy and in vivo reflectance confocal microscopy (RCM) to aid in the detection of treatment failure of LM following nonsurgical treatment. METHODS A retrospective study of dermoscopy and RCM images (blinded to the correlation with pathology) in patients with biopsy-confirmed LM who were undergoing nonsurgical treatment in two referral institutions - one in Sydney, Australia, and the other in Barcelona, Spain. Ninety-eight patients were treated nonsurgically for LM during the period 2006-2012. Thirty-one patients had abnormal dermoscopy or RCM evaluation, and had a biopsy that identified LM recurrence in 15 patients and nonmelanoma diagnoses in 16 patients (one Bowen disease, 15 solar changes). RESULTS The diagnosis of treatment failure was difficult with dermoscopy, with a sensitivity of 80% and specificity of 56%, even with the interpretation of an expert. The best criterion was asymmetric hyperpigmented follicular openings, but this was present in only 47% of treatment failure LM. Isolated, very fine brown dots ('dust' appearance) correlated highly with the diagnosis of treatment failure LM (73% sensitivity and 88% specificity) and with pagetoid cells seen with RCM. The LM score, comprising six criteria, had a specificity of 94% and sensitivity of 100%. CONCLUSIONS These methods and descriptors should help to manage the diagnosis of treatment failure.
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Affiliation(s)
- P Guitera
- Melanoma Institute Australia, Poche Centre, 40 Rocklands Road, North Sydney, NSW, 2060, Australia; Department of Sydney Melanoma Diagnostic Centre, Missenden Road Camperdown, NSW, 2050, Australia; Discipline of Dermatology, The University of Sydney, Sydney, NSW, Australia
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91
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Ciudad-Blanco C, Avilés-Izquierdo JA, Lázaro-Ochaita P, Suárez-Fernández R. Dermoscopic findings for the early detection of melanoma: an analysis of 200 cases. ACTAS DERMO-SIFILIOGRAFICAS 2014; 105:683-93. [PMID: 24704190 DOI: 10.1016/j.ad.2014.01.008] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2013] [Revised: 01/24/2014] [Accepted: 01/29/2014] [Indexed: 11/26/2022] Open
Abstract
INTRODUCTION Dermoscopy is a complementary technique that has led to major advances in the diagnosis of pigmented skin lesions. The aim of this study was to describe the dermoscopic features of a series of melanomas and analyze the differences between melanomas in situ and invasive melanomas. MATERIAL AND METHODS We retrospectively recorded epidemiological, clinical, histologic, and dermoscopic features of a series of 200 primary melanomas. We performed a descriptive and analytical study of the dermoscopic features identified. RESULTS The mean age of the patients was 63 years and there was a similar distribution of male and female patients. The most common histologic subtypes were superficial spreading melanoma (62.5%) and lentigo maligna (25.5%); 67% of the melanomas had a Breslow thickness of less than 1mm and 24.5% were melanomas in situ. Overall,the most common global dermoscopic features were the multicomponent pattern (33.5%), the reticular pattern (18%), and the nonspecific pattern (15.5%). The most common local features were structureless homogeneous areas (67.5%), white-blue structures (58%), an atypical pigmented network (55.5%), and irregularly distributed dots and globules (44%). The following features were more common in invasive melanomas than in melanomas in situ: blue, gray, red and white colors, multicomponent and homogeneous patterns, dots and globules, blue-white structures, homogeneous areas, a blue-white veil, white shiny structures, a reverse pigment network, and milky-red areas. The reticular pattern was more common in melanomas in situ. DISCUSSION The use of dermoscopy has contributed to the early diagnosis of melanoma. The most common dermoscopic features of melanoma are multiple structures and colors (multicomponent pattern), an atypical reticular pattern (with wide, irregular meshes), and an absence of distinguishing features (nonspecific pattern) associated with the presence of vascular structures. CONCLUSIONS Dermoscopy facilitates the diagnosis of melanoma and could be useful for differentiating between melanoma in situ and invasive melanoma.
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Affiliation(s)
- C Ciudad-Blanco
- Servicio de Dermatología, Hospital General Universitario Gregorio Marañón, Madrid, España.
| | - J A Avilés-Izquierdo
- Servicio de Dermatología, Hospital General Universitario Gregorio Marañón, Madrid, España
| | | | - R Suárez-Fernández
- Servicio de Dermatología, Hospital General Universitario Gregorio Marañón, Madrid, España
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92
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Tschandl P, Rosendahl C, Kittler H. Dermatoscopy of flat pigmented facial lesions. J Eur Acad Dermatol Venereol 2014; 29:120-7. [PMID: 24661420 DOI: 10.1111/jdv.12483] [Citation(s) in RCA: 64] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2013] [Accepted: 02/20/2014] [Indexed: 11/26/2022]
Abstract
BACKGROUND The diagnosis of flat pigmented lesions on the face is challenging because of the morphologic overlap of biologically different lesions and the unknown significance of dermatoscopic patterns. OBJECTIVE To better characterize dermatoscopic patterns of various types of flat pigmented facial lesions and to analyse their significance by calculating their relative risks and diagnostic values. METHODS We prospectively analysed dermatoscopic images of 240 flat pigmented facial skin lesions collected consecutively from 195 patients (41.5% females, mean age: 61 ± 14 years) between 2007 and March 2012 in a primary skin cancer practice situated in Queensland, Australia. RESULTS Histopathologically 114 (47.5%) lesions were malignant (24 lentigo maligna, 21 basal cell carcinomas and 69 pigmented actinic keratoses). Compared with all other patterns the positive predictive value for lentigo maligna was highest for a pattern of circles (31.3%, 95% CI: 11.1-58.6%). A pattern of clods was associated with basal cell carcinoma. If grey structures were present the relative risk for malignancy was 2.2 (95%CI: 1.4-3.4). The best clues to differentiate pigmented actinic keratosis from other lesions were the presence of scale (positive predictive value: 72.2%, specificity: 94.2%), white circles (positive predictive value: 68.8%, specificity: 94.2%) and a sharply demarcated border (positive predictive value: 44.2%, specificity: 86.0%). CONCLUSIONS In flat lesions a pattern of circles bears the highest risk for facial melanoma but other patterns do not exclude it. Scale, white circles and a sharply demarcated border are clues to pigmented actinic keratoses. The presence of grey colour is a clue to malignancy regardless of pattern.
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Affiliation(s)
- P Tschandl
- Department of Dermatology, Division of General Dermatology, Medical University of Vienna, Vienna, Austria
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93
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Giacomel J, Lallas A, Zalaudek I, Argenziano G. Dermoscopic “signature” pattern of pigmented and nonpigmented lentigo maligna. J Am Acad Dermatol 2014; 70:e33-5. [DOI: 10.1016/j.jaad.2013.08.045] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2013] [Revised: 08/22/2013] [Accepted: 08/29/2013] [Indexed: 11/26/2022]
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Longo C, Bassoli S, Farnetani F, Ferrari B, Pupelli G, Seidenari S, Pellacani G. Reflectance confocal microscopy for melanoma and melanocytic lesion assessment. ACTA ACUST UNITED AC 2014. [DOI: 10.1586/17469872.3.6.735] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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95
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Zalaudek I, Leinweber B, Hofmann-Wellenhof R, Soyer HP. The impact of dermoscopic–pathological correlates in the diagnosis and management of pigmented skin tumors. ACTA ACUST UNITED AC 2014. [DOI: 10.1586/17469872.1.4.579] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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96
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Abstract
Lentigo maligna is a melanocytic neoplasm, often regarded as 'melanoma in situ,' which may progress to lentigo maligna melanoma. Lentigo maligna clinically presents as a pigmented, asymmetric macule that originates on the head and neck and spreads slowly. The preferred method for diagnosing lentigo maligna is excisional biopsy. Histology shows proliferation of atypical melanocytes at the epidermal-dermal junction in small nests or single cells. The differential diagnosis includes solar lentigo, seborrheic keratosis, lichen planus-like keratosis, pigmented actinic keratosis, and melanocytic nevus. Stains used in diagnosis include hematoxylin and eosin, HMB-45, MART-1/Melan-A, Mel-5, and S-100. Surgical excision is the preferred treatment for lentigo maligna. Second-line techniques include medical (topical imiquimod) and destructive therapy.
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97
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Samaniego E, Redondo P. Lentigo Maligna. ACTAS DERMO-SIFILIOGRAFICAS 2013. [DOI: 10.1016/j.adengl.2012.05.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
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98
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Samaniego E, Redondo P. Lentigo maligno. ACTAS DERMO-SIFILIOGRAFICAS 2013; 104:757-75. [DOI: 10.1016/j.ad.2012.05.006] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2011] [Revised: 04/28/2012] [Accepted: 05/19/2012] [Indexed: 11/16/2022] Open
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100
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Lin J, Han S, Cui L, Song Z, Gao M, Yang G, Fu Y, Liu X. Evaluation of dermoscopic algorithm for seborrhoeic keratosis: a prospective study in 412 patients. J Eur Acad Dermatol Venereol 2013; 28:957-62. [PMID: 23980820 DOI: 10.1111/jdv.12241] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2013] [Revised: 05/09/2013] [Accepted: 07/19/2013] [Indexed: 11/30/2022]
Affiliation(s)
- J. Lin
- Department of Dermatology; 1st Affiliated Hospital of Dalian Medical University; Dalian China
| | - S. Han
- Department of Dermatology; 1st Affiliated Hospital of Dalian Medical University; Dalian China
| | - L. Cui
- Department of Dermatology; 1st Affiliated Hospital of Dalian Medical University; Dalian China
| | - Z. Song
- Department of Dermatology; 1st Affiliated Hospital of Dalian Medical University; Dalian China
| | - M. Gao
- Department of Dermatology; 1st Affiliated Hospital of Dalian Medical University; Dalian China
| | - G. Yang
- Department of Dermatology; 1st Affiliated Hospital of Dalian Medical University; Dalian China
| | - Y. Fu
- Department of Dermatology; 1st Affiliated Hospital of Dalian Medical University; Dalian China
| | - X. Liu
- Department of Dermatology; 1st Affiliated Hospital of Dalian Medical University; Dalian China
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