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Pizzichetta MA, Polesel J, Perrot JL, Rubegni P, Stanganelli I, Magi S, Mazzoni L, Farnetani F, Pellacani G, Garutti M, Puglisi F, Cinotti E. The combination of dermoscopy and reflectance confocal microscopy increases the diagnostic confidence of amelanotic/hypomelanotic lentigo maligna. J Dermatol 2024; 51:714-718. [PMID: 38217366 PMCID: PMC11484130 DOI: 10.1111/1346-8138.17075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Revised: 11/21/2023] [Accepted: 11/27/2023] [Indexed: 01/15/2024]
Abstract
The dermoscopic diagnosis of amelanotic/hypomelanotic lentigo maligna/lentigo maligna melanoma (AHLM/LMM) may be very difficult in its early stages because of lack of pigment. Reflectance confocal microscopy (RCM) is an imaging technique that is especially helpful for the diagnosis of lentigo maligna. To determine the diagnostic performances of dermoscopy and RCM in the diagnosis of AHLM/LMMs we evaluated dermoscopic and RCM images of consecutive cases of histopathologically confirmed AHLM/LMMs, amelanotic/hypomelanotic basal cell carcinoma and squamous cell carcinoma (AHBCCs/AHSCCs), amelanotic/hypomelanotic benign lesions (AHBLs), and actinic keratoses (AKs) from five participating centers. Sensitivity, specificity, accuracy, predictive values, and level of diagnosis confidence were calculated for both diagnostic procedures. Both dermoscopy and RCM showed diagnostic performance >97% in the diagnosis of AHLM/LMMs versus AHBCC/AHSCCs and their combination slightly improved diagnostic performance, with accuracy increasing from 98.0% to 99.1%. Similarly, RCM in combination with dermoscopy showed a tiny increase in the diagnostic performance in the diagnosis of AHLM/LMMs versus AHBLs (accuracy increased from 87.2% to 88.8%) and versus AKs (accuracy increased from 91.4% to 93.4%). Although the increase in diagnostic performance due to RCM was modest, the combination of dermoscopy and RCM greatly increased the level of confidence; high confidence in the diagnosis of AHLM/LMMs versus AHBLs increased from 36.2% with dermoscopy alone to 76.6% with dermoscopy plus RMC. Based on our results, dermoscopy and RCM should be complementary to improve not only diagnostic accuracy but also the level of diagnostic certainty in the diagnosis of AHLM/LMMs.
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MESH Headings
- Humans
- Dermoscopy
- Microscopy, Confocal/methods
- Skin Neoplasms/pathology
- Skin Neoplasms/diagnostic imaging
- Skin Neoplasms/diagnosis
- Hutchinson's Melanotic Freckle/pathology
- Hutchinson's Melanotic Freckle/diagnosis
- Hutchinson's Melanotic Freckle/diagnostic imaging
- Sensitivity and Specificity
- Diagnosis, Differential
- Female
- Aged
- Male
- Carcinoma, Basal Cell/diagnostic imaging
- Carcinoma, Basal Cell/pathology
- Carcinoma, Basal Cell/diagnosis
- Carcinoma, Squamous Cell/diagnostic imaging
- Carcinoma, Squamous Cell/pathology
- Carcinoma, Squamous Cell/diagnosis
- Middle Aged
- Keratosis, Actinic/diagnostic imaging
- Keratosis, Actinic/pathology
- Keratosis, Actinic/diagnosis
- Melanoma, Amelanotic/pathology
- Melanoma, Amelanotic/diagnostic imaging
- Melanoma, Amelanotic/diagnosis
- Aged, 80 and over
- Predictive Value of Tests
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Affiliation(s)
- Maria Antonietta Pizzichetta
- Department of DermatologyUniversity of TriesteTriesteItaly
- Department of Medical OncologyCentro di Riferimento Oncologico di Aviano IRCCS, Istituto di ricovero e cura a carattere scientificoAvianoItaly
| | - Jerry Polesel
- Cancer Epidemiology UnitCentro di Riferimento Oncologico di Aviano IRCCSAvianoItaly
| | - Jean Luc Perrot
- Department of DermatologyUniversity Hospital of Saint EtienneSaint‐EtienneFrance
| | - Pietro Rubegni
- Department of Medical, Surgical and Neurological Science, Dermatology SectionUniversity of Siena, S. Maria alle Scotte HospitalSienaItaly
| | - Ignazio Stanganelli
- Department of DermatologyUniversity of Parma‐Skin Cancer Unit, Istituto Scientifico Romagnolo per lo Studio dei Tumori "Dino Amadori" IRCCSMeldolaItaly
- Skin Cancer UnitIRCCS Istituto Romagnolo per lo Studio dei Tumori "Dino Amadori"MeldolaItaly
| | - Serena Magi
- Skin Cancer UnitIRCCS Istituto Romagnolo per lo Studio dei Tumori "Dino Amadori"MeldolaItaly
| | - Laura Mazzoni
- Skin Cancer UnitIRCCS Istituto Romagnolo per lo Studio dei Tumori "Dino Amadori"MeldolaItaly
| | | | - Giovanni Pellacani
- Department of Dermatology, Policlinico Umberto ISapienza University of RomeRomeItaly
| | - Mattia Garutti
- Department of Medical OncologyCentro di Riferimento Oncologico di Aviano IRCCS, Istituto di ricovero e cura a carattere scientificoAvianoItaly
| | - Fabio Puglisi
- Department of Medical OncologyCentro di Riferimento Oncologico di Aviano IRCCS, Istituto di ricovero e cura a carattere scientificoAvianoItaly
- Department of MedicineUniversity of UdineUdineItaly
| | - Elisa Cinotti
- Department of Medical, Surgical and Neurological Science, Dermatology SectionUniversity of Siena, S. Maria alle Scotte HospitalSienaItaly
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Pizzichetta MA, Polesel J, Perrot JL, Rubegni P, Fiorani D, Rizzo A, Stanganelli I, Magi S, Mazzoni L, Medri M, Dominici MM, Toffolutti F, Farnetani F, Lippolis N, Pedroni G, Ciardo S, Condorelli AG, Conforti C, Pellacani G, Zalaudek I, Puglisi F, Cinotti E. Amelanotic/hypomelanotic lentigo maligna: Dermoscopic and confocal features predicting diagnosis. J Eur Acad Dermatol Venereol 2023; 37:303-310. [PMID: 36196781 PMCID: PMC10092015 DOI: 10.1111/jdv.18636] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Accepted: 09/12/2022] [Indexed: 01/18/2023]
Abstract
BACKGROUND Amelanotic/hypomelanotic lentigo maligna and lentigo maligna melanoma (AHLM/LMM) may be very difficult to diagnose at an early stage. OBJECTIVES To quantify the predictive value of dermoscopic and reflectance confocal microscopy (RCM) features for AHLM/LMM. METHODS Dermoscopic and RCM images of histopathologically diagnosed AHLM/LMM, amelanotic/hypomelanotic benign lesions (AHBL), and amelanotic/hypomelanotic basal and squamous cell carcinomas (AHBCC/AHSCC) of the head and neck from consecutive patients were retrospectively collected and blindly evaluated by three observers to assess presence or absence of dermoscopic and RCM criteria. RESULTS Overall, 224 lesions in 216 patients including LM/LMM (n = 55, 24.6%), AHBL (n = 107, 47.8%) and AHBCC/AHSCC (n = 62, 27.7%) were analysed. Multivariable analysis showed that milky-red areas (OR = 5.46; 95% CI: 1.51-19.75), peripheral light brown structureless areas (OR = 19.10; 4.45-81.96), linear irregular vessels (OR = 5.44; 1.45-20.40), and asymmetric pigmented follicles (OR = 14.45; 2.77-75.44) at dermoscopy, and ≥3 atypical cells in five fields (OR = 10.12; 3.00-34.12) and focal follicular localization of atypical cells at dermo-epidermal junction (DEJ) (OR = 10.48; 1.10-99.81) at RCM were significantly independent diagnostic factors for AHLM/LMM vs. AHBL. In comparison with AHBCC/AHSCC, peripheral light brown structureless area (OR = 7.11; 1.53-32.96), pseudonetwork around hair follicles (OR = 16.69; 2.73-102.07), and annular granular structures (OR = 42.36; 3.51-511.16) at dermoscopy and large dendritic (OR = 6.86; 3.15-38.28) and round pagetoid cells (OR = 26.78; 3.15-227.98) at RCM led to a significantly increased risk of diagnosing AHLM/LMM. CONCLUSIONS Amelanotic/hypomelanotic lentigo maligna and lentigo maligna melanoma may have the same dermoscopic features of AHM on other body sites, such as milky red areas, peripheral light brown structureless areas and linear irregular vessels. These features, asymmetric pigmented follicles and at RCM ≥ 3 atypical cells in five fields and focal follicular extension of atypical cells at DEJ may help in recognizing AHLM/LMM even when LM conventional features (e.g., obliteration of hair follicles under dermoscopy and large pagetoid cells under RCM) are absent or present only in very small areas of the lesion.
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Affiliation(s)
- Maria A Pizzichetta
- Department of Dermatology, University of Trieste, Trieste, Italy.,Department of Medical Oncology, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, Aviano, Italy
| | - Jerry Polesel
- Cancer Epidemiology Unit, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, Aviano, Italy
| | - Jean L Perrot
- Department of Dermatology, University Hospital of Saint Etienne, Saint-Etienne, France
| | - Pietro Rubegni
- Department of Medical, Surgical and Neurological Science, Dermatology Section, University of Siena, S. Maria alle Scotte Hospital, Siena, Italy
| | - Diletta Fiorani
- Department of Medical, Surgical and Neurological Science, Dermatology Section, University of Siena, S. Maria alle Scotte Hospital, Siena, Italy
| | - Arianna Rizzo
- Department of Medical, Surgical and Neurological Science, Dermatology Section, University of Siena, S. Maria alle Scotte Hospital, Siena, Italy
| | - Ignazio Stanganelli
- Department of Dermatology, University of Parma, Parma, Italy.,Skin Cancer Unit, Istituto Scientifico Romagnolo per lo Studio dei Tumori "Dino Amadori" (IRST) IRCCS, Meldola, Italy
| | - Serena Magi
- Skin Cancer Unit, Istituto Scientifico Romagnolo per lo Studio dei Tumori "Dino Amadori" (IRST) IRCCS, Meldola, Italy
| | - Laura Mazzoni
- Skin Cancer Unit, Istituto Scientifico Romagnolo per lo Studio dei Tumori "Dino Amadori" (IRST) IRCCS, Meldola, Italy
| | - Matelda Medri
- Skin Cancer Unit, Istituto Scientifico Romagnolo per lo Studio dei Tumori "Dino Amadori" (IRST) IRCCS, Meldola, Italy
| | - Michele M Dominici
- Division of Dermatology, Department of Medicina and Surgery, Azienda Ospedaliera-Universitaria di Parma, Parma, Italy
| | - Federica Toffolutti
- Cancer Epidemiology Unit, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, Aviano, Italy
| | - Francesca Farnetani
- Department of Dermatology, University of Modena and Reggio Emilia, Modena, Italy
| | - Nicola Lippolis
- Department of Dermatology, University of Modena and Reggio Emilia, Modena, Italy
| | - Gioia Pedroni
- Department of Dermatology, University of Modena and Reggio Emilia, Modena, Italy
| | - Silvana Ciardo
- Department of Dermatology, University of Modena and Reggio Emilia, Modena, Italy
| | - Alessandra G Condorelli
- Dermatologic Unit, Department of Medical Specialities Arcispedale Santa Maria Nuova, IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Claudio Conforti
- Department of Dermatology, University of Trieste, Trieste, Italy
| | - Giovanni Pellacani
- Department of Dermatology, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
| | - Iris Zalaudek
- Department of Dermatology, University of Trieste, Trieste, Italy
| | - Fabio Puglisi
- Department of Medical Oncology, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, Aviano, Italy.,Department of Medicine (DAME), University of Udine, Udine, Italy
| | - Elisa Cinotti
- Department of Medical, Surgical and Neurological Science, Dermatology Section, University of Siena, S. Maria alle Scotte Hospital, Siena, Italy
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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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