Dermoscopic Findings for the Early Detection of Melanoma: An Analysis of 200 Cases

Morphological evolution in melanoma in situ using revised pattern analysis

Sequential digital dermoscopic imaging (SDDI) compares surface microscopy images of skin lesions over multiple time points. We utilized a retrospective SDDI cohort to investigate the development of dermoscopic features associated with malignancy in melanoma in situ (MIS). A total of 124 in situ melanomas were assessed from 110 Caucasian patients aged ≥18 years, with ≥2 serial images obtained between 1999 and 2017 and followed for a mean 41 months (3-142). As a positive control group, 58 invasive melanomas from 53 patients were also reviewed. Change in MIS size or number of colours correlated to time (both p < .001). The odds of MIS displaying ≥3 clues to malignancy also correlated to time (OR 5.6-52.1) (p < .05). 75% of in situ melanomas matched a dermoscopic subtype on final imaging. While a clinically significant minority of in situ melanomas were unchanged or lost dermoscopic features, lesions predominantly increased in morphological complexity over time. Longer follow-up periods allow dermoscopic features associated with malignancy and histopathological progression to develop.

Mycobacterium bovis BCG in metastatic melanoma therapy

Melanoma is the most aggressive form of skin cancer, with a high mortality rate and with 96,480 new cases expected in 2019 in the USS. BRAF^V600E, the most common driver mutation, is found in around 50% of melanomas, contributing to tumor growth, angiogenesis, and metastatic progression. Dacarbazine (DTIC), an alkylate agent, was the first chemotherapeutic agent approved by the US Food and Drug Administration (FDA) used as a standard treatment. Since then, immunotherapies have been approved for metastatic melanoma (MM) including ipilimumab and pembrolizumab checkpoint inhibitors that help decrease the risk of progression. Moreover, Mycobacterium bovis Bacillus Calmette-Guerin (BCG) serves as an adjuvant therapy that induces the recruitment of natural killer NK, CD4⁺, and CD8⁺ T cells and contributes to antitumor immunity. BCG can be administered in combination with chemotherapeutic and immunotherapeutic agents and can be genetically manipulated to produce recombinant BCG (rBCG) strains that express heterologous proteins or overexpress immunogenic proteins, increasing the immune response and improving patient survival. In this review, we highlight several studies utilizing rBCG immunotherapy for MM in combination with other therapeutic agents.

Dermoscopic characteristics of melanoma according to the criteria "ulceration" and "mitotic rate" of the AJCC 2009 staging system for melanoma

OBJECTIVE

The present study was conducted to identify possible dermoscopic patterns, associated with mitotic rate > 1/mm2, histological ulceration in melanoma and metastatic disease.

METHODS

For this retrospective data analysis all clinical and dermoscopic digital images of primary malignant melanomas between 2008 and 2013 documented at the Department of Dermatology Graz were included, using the internal image data-base. 550 patients with 559 melanomas were included.

RESULTS

While clinical or dermoscopic analysis considered ulceration to be present in 120 (21.5%) and 117 (20.9%) of all lesions, respectively, histopathology reported ulceration in only 96 cases (17.2%). The presence of milky-red areas, shiny-white streaks, a blue-white veil and blue-grey areas in dermoscopy is highly correlated with histological ulceration and a mitotic rate > 1/mm2. The dermoscopic patterns shiny-white streaks, milky-red areas and blue-white veil were also significantly associated with development of distant metastases.

CONCLUSION

Our study proves a significant correlation between the dermoscopic patterns "blue white veil", "milky-red areas"and "shiny-white streaks"and the histological findings "ulceration"and "mitotic rate > 1/mm2". Furthermore these dermoscopic patterns are highly related to distant metastases. Thus, dermoscopy renders earlier prognostic statements possible.