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Tognetti L, Cartocci A, Żychowska M, Savarese I, Cinotti E, Pizzichetta MA, Moscarella E, Longo C, Farnetani F, Guida S, Paoli J, Lallas A, Tiodorovic D, Stanganelli I, Magi S, Dika E, Zalaudek I, Suppa M, Argenziano G, Pellacani G, Perrot JL, Miracapillo C, Rubegni G, Cevenini G, Rubegni P. A risk-scoring model for the differential diagnosis of lentigo maligna and other atypical pigmented facial lesions of the face: The facial iDScore. J Eur Acad Dermatol Venereol 2023; 37:2301-2310. [PMID: 37467376 DOI: 10.1111/jdv.19360] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Accepted: 07/07/2023] [Indexed: 07/21/2023]
Abstract
BACKGROUND Due to progressive ageing of the population, the incidence of facial lentigo maligna (LM) of the face is increasing. Many benign simulators of LM and LMM, known as atypical pigmented facial lesions (aPFLs-pigmented actinic keratosis, solar lentigo, seborrheic keratosis, seborrheic-lichenoid keratosis, atypical nevus) may be found on photodamaged skin. This generates many diagnostic issues and increases the number of biopsies, with a subsequent impact on aesthetic outcome and health insurance costs. OBJECTIVES Our aim was to develop a risk-scoring classifier-based algorithm to estimate the probability of an aPFL being malignant. A second aim was to compare its diagnostic accuracy with that of dermoscopists so as to define the advantages of using the model in patient management. MATERIALS AND METHODS A total of 154 dermatologists analysed 1111 aPFLs and their management in a teledermatology setting: They performed pattern analysis, gave an intuitive clinical diagnosis and proposed lesion management options (follow-up/reflectance confocal microscopy/biopsy). Each case was composed of a dermoscopic and/or clinical picture plus metadata (histology, age, sex, location, diameter). The risk-scoring classifier was developed and tested on this dataset and then validated on 86 additional aPFLs. RESULTS The facial Integrated Dermoscopic Score (iDScore) model consisted of seven dermoscopic variables and three objective parameters (diameter ≥ 8 mm, age ≥ 70 years, male sex); the score ranged from 0 to 16. In the testing set, the facial iDScore-aided diagnosis was more accurate (AUC = 0.79 [IC 95% 0.757-0.843]) than the intuitive diagnosis proposed by dermatologists (average of 43.5%). In the management study, the score model reduced the number of benign lesions sent for biopsies by 41.5% and increased the number of LM/LMM cases sent for reflectance confocal microscopy or biopsy instead of follow-up by 66%. CONCLUSIONS The facial iDScore can be proposed as a feasible tool for managing patients with aPFLs.
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Affiliation(s)
- Linda Tognetti
- Dermatology Unit, Department of Medical, Surgical and Neurosciences, University of Siena, Siena, Italy
| | - Alessandra Cartocci
- Dermatology Unit, Department of Medical, Surgical and Neurosciences, University of Siena, Siena, Italy
- Department of Medical Biotechnologies, University of Siena, Siena, Italy
| | - Magdalena Żychowska
- Department of Dermatology, Institute of Medical Sciences, Medical College of Rzeszow University, Rzeszów, Poland
| | - Imma Savarese
- Soc Dermatologia Pistoia-Prato, USL Toscana Centro, Pistoia, Italy
| | - Elisa Cinotti
- Dermatology Unit, Department of Medical, Surgical and Neurosciences, University of Siena, Siena, Italy
| | - Maria Antonietta Pizzichetta
- Dermatology Clinic, Ospedale di Trieste, Trieste, Italy
- Department of Medical Oncology, Centro di Riferimento Oncologico di Aviano (CRO), IRCCS, Aviano, Italy
| | - Elvira Moscarella
- Dermatology Unit, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Caterina Longo
- Centro Oncologico ad Alta Tecnologia Diagnostica, Azienda Unità Sanitaria Locale, IRCCS di Reggio Emilia, Reggio Emilia, Italy
- Department of Dermatology, University of Modena and Reggio Emilia, Modena, Italy
| | - Francesca Farnetani
- Department of Dermatology, University of Modena and Reggio Emilia, Modena, Italy
| | - Stefania Guida
- Vita-Salute San Raffaele University, Milan, Italy
- Dermatology Clinic, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - John Paoli
- Department of Dermatology and Venereology, Institute of Clinical Sciences, Sahlgrenska Academy, Sahlgrenska University Hospital, University of Gothenburg, Gothenburg, Sweden
- Department of Dermatology and Venereology, Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Aimilios Lallas
- First Department of Dermatology, Aristotle University, Thessaloniki, Greece
| | | | - Ignazio Stanganelli
- Skin Cancer Unit, Scientific Institute of Romagna for the Study of Cancer, IRCCS, IRST, Meldola, Italy
- Department of Dermatology, University of Parma, Parma, Italy
| | - Serena Magi
- Skin Cancer Unit, Scientific Institute of Romagna for the Study of Cancer, IRCCS, IRST, Meldola, Italy
| | - Emi Dika
- Dermatology Unit, Department of Experimental, Diagnostic and Specialty Medicine (DIMES), University of Bologna, Bologna, Italy
- Dermatology, IRCCS Azienda Ospedaliero Universitaria di Bologna, Bologna, Italy
| | - Iris Zalaudek
- Dermatology Clinic, Ospedale di Trieste, Trieste, Italy
| | - Mariano Suppa
- Department of Dermatology, Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium
- Groupe d'Imagerie Cutanée Non-Invasive, Société Française de Dermatologie, Paris, France
- Department of Dermatology, Institut Jules Bordet, Brussels, Belgium
| | | | - Giovanni Pellacani
- Department of Dermatology, Policlinico Umberto I, University of Rome La Sapienza, Rome, Italy
| | - Jean Luc Perrot
- Dermatology Unit, University Hospital of St-Etienne, Saint Etienne, France
| | - Chiara Miracapillo
- Dermatology Unit, Department of Medical, Surgical and Neurosciences, University of Siena, Siena, Italy
| | - Giovanni Rubegni
- Department of Ophthalmology, University of Catania, Catania, Italy
| | - Gabriele Cevenini
- Bioengineering and Biomedical Data Science Lab, Department of Medical Biotechnologies, University of Siena, Siena, Italy
| | - Pietro Rubegni
- Dermatology Unit, Department of Medical, Surgical and Neurosciences, University of Siena, Siena, Italy
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Das A, Madke B, Jakhar D, Neema S, Kaur I, Kumar P, Pradhan S. Named signs and metaphoric terminologies in dermoscopy: A compilation. Indian J Dermatol Venereol Leprol 2022; 88:855-866. [PMID: 35146985 DOI: 10.25259/ijdvl_1047_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Accepted: 06/01/2021] [Indexed: 02/03/2023]
Affiliation(s)
- Anupam Das
- Department of Dermatology, KPC Medical College and Hospital, Kolkata, West Bengal, India
| | - Bhushan Madke
- Department of Dermatology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Medical Sciences, Sawangi, Wardha, Maharashtra, India
| | - Deepak Jakhar
- Department of Dermatology, North DMC Medical College and Hindu Rao Hospital, New Delhi, India
| | - Shekhar Neema
- Department of Dermatology, Armed Forces Medical College, Pune, Maharashtra, India
| | - Ishmeet Kaur
- Department of Dermatology, North DMC Medical College and Hindu Rao Hospital, New Delhi, India
| | - Piyush Kumar
- Department of Dermatology, Katihar Medical College, Katihar, Bihar, India
| | - Swetalina Pradhan
- Department of Dermatology, All India Institute of Medical Sciences, Patna, Bihar, India
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Pigmented lesion on the face: which is the chance of being melanoma using reflectance confocal microscopy features? Arch Dermatol Res 2021; 314:563-571. [PMID: 34152481 DOI: 10.1007/s00403-021-02263-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Revised: 03/30/2021] [Accepted: 06/11/2021] [Indexed: 10/21/2022]
Abstract
Facial melanoma presents itself as a brownish macula, being difficult to differentiate it from benign pigmented lesions of the face on clinical examination. Reflectance confocal microscopy (RCM) assists in diagnosing facial lesions in which dermoscopy has limitations, allowing to increase the diagnostic accuracy. The study aimed to analyze the RCM features of pigmented isolated lesions of the face for diagnosing melanoma. Also, we sought to establish the chance of a pigmented lesion on the face being a melanoma using RCM criteria. In this retrospective and prospective study, 105 clinical pigmented lesions on the face underwent RCM, and cytoarchitectural features in the epidermis, the dermo-epidermal junction (DEJ), and dermis were described. For statistical analysis, the exact chi-square test was applied to the RCM criteria. The odds ratio was estimated using univariate logistic regression. Finally, we used the multiple logistic regression method for creating a nomogram to predict the chance of a lesion being a melanoma. After univariate and multivariate logistic regression, atypical round nucleated cells within the epidermis, pagetoid spread, and follicular dendritic cells presented as statistically significant features. Then, a complex nomogram was created to give the chance of a pigmented lesion on the face being a melanoma. The presence of these three features resulted in a 98% probability for melanoma. This study allowed to estimate the diagnosis of melanoma on the face, using RCM, practicable and feasible in the daily routine, through the presence of some RCM nomogram criteria.
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Cinotti E, Fiorani D, Labeille B, Gonzalez S, Debarbieux S, Agozzino M, Ardigò M, Lacarrubba F, Farnetani F, Carrera C, Cevenini G, Le Duff F, Tognetti L, Pellacani G, Rubegni P, Perrot JL. The integration of dermoscopy and reflectance confocal microscopy improves the diagnosis of lentigo maligna. J Eur Acad Dermatol Venereol 2019; 33:e372-e374. [PMID: 31074539 DOI: 10.1111/jdv.15669] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- E Cinotti
- Dermatology Section, Department of Medical, Surgical and Neurological Science, S. Maria alle Scotte Hospital, University of Siena, Siena, Italy
| | - D Fiorani
- Dermatology Section, Department of Medical, Surgical and Neurological Science, S. Maria alle Scotte Hospital, University of Siena, Siena, Italy
| | - B Labeille
- Department of Dermatology, University Hospital of St-Etienne, Saint-Etienne, France
| | - S Gonzalez
- Medicine and Medical Specialities Department, Alcalá University, Madrid, Spain
| | - S Debarbieux
- Departments of Dermatology, Centre Hospitalier Lyon Sud, Pierre Benite, France
| | - M Agozzino
- Dermatology Unit, University of Campania Luigi Vanvitelli, Naples, Italy
| | - M Ardigò
- Clinical Dermatology, San Gallicano Dermatological Institute, Rome, Italy
| | - F Lacarrubba
- Dermatology Clinic, University of Catania, Catania, Italy
| | - F Farnetani
- Department of Dermatology, University of Modena and Reggio Emilia, Modena, Italy
| | - C Carrera
- Melanoma Unit, Department of Dermatology, Hospital Clínic de Barcelona, IDIBAPS, Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), Barcelona University, Barcelona, Spain
| | - G Cevenini
- Department of Medical Biotechnologies, University of Siena, Siena, Italy
| | - F Le Duff
- Department of Dermatology, Clinical Research Center, Hopital Archet 2, Nice, France
| | - L Tognetti
- Dermatology Section, Department of Medical, Surgical and Neurological Science, S. Maria alle Scotte Hospital, University of Siena, Siena, Italy.,Department of Medical Biotechnologies, University of Siena, Siena, Italy
| | - G Pellacani
- Department of Dermatology, University of Modena and Reggio Emilia, Modena, Italy
| | - P Rubegni
- Dermatology Section, Department of Medical, Surgical and Neurological Science, S. Maria alle Scotte Hospital, University of Siena, Siena, Italy
| | - J L Perrot
- Department of Dermatology, University Hospital of St-Etienne, Saint-Etienne, France
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Wollina U, Hansel G, Schmidt N, Schönlebe J, Kittner T, Nowak A. Very Rare Amelanotic Lentigo Maligna Melanoma with Skull Roof Invasion. Open Access Maced J Med Sci 2017; 5:458-461. [PMID: 28785332 PMCID: PMC5535657 DOI: 10.3889/oamjms.2017.113] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2017] [Revised: 05/04/2017] [Accepted: 05/05/2017] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND Lentigo malignant melanoma is a melanoma subtype of chronic sun-damaged skin in elderly Caucasians. Amelanotic variants of lentigo malignant are extremely rare. CASE PRESENTATION This is a case report of an 80-year-old male patient who presented with a non-pigmented exophytic tumour of his bald head. After complete surgical excision under the suspicion of squamous cell carcinoma, three-dimensional histologic examination confirmed an amelanotic lentigo malignant melanoma with a tumour thickness of 1.76 mm, resected R0. Five years later he developed the first relapse, the other year a satellite metastasis was surgically removed. One year later, this patient had developed a large relapsing lentigo malignant melanoma with skull roof invasion. There was no evidence of distant metastatic spread. Amelanotic lentigo malignant melanoma is a very rare tumour. CONCLUSIONS Serial excision or slow Mohs and Mohs micrographic surgery are the treatments of choice especially in the head and neck area. These tumours may be locally very aggressive as it is shown by skull invasion in the present case.
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Affiliation(s)
- Uwe Wollina
- Department of Dermatology and Allergology, Academic Teaching Hospital Dresden-Friedrichstadt in Dresden, Dresden, Germany
| | - Gesina Hansel
- Department of Dermatology and Allergology, Academic Teaching Hospital Dresden-Friedrichstadt in Dresden, Dresden, Germany
| | - Nadine Schmidt
- Department of Dermatology and Allergology, Academic Teaching Hospital Dresden-Friedrichstadt in Dresden, Dresden, Germany
| | - Jacqueline Schönlebe
- Städtisches Klinikum Dresden - Institute of Pathology "Georg Schmorl", Dresden, Germany
| | - Thomas Kittner
- Stadtisches Klinikum Dresden, Department of Radiology, Dresden, Sachsen, Germany
| | - Andreas Nowak
- Department of Anesthesiology & Intensive Care Medicine, Emergency Medicine & Pain Management, Hospital Dresden-Friedrichstadt, Academic Teaching Hospital of the Technical University of Dresden, Friedrichstrasse 41, 01067, Dresden, Germany
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