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Soglia S, Pérez-Anker J, Albero R, Alós L, Berot V, Castillo P, Cinotti E, Del Marmol V, Fakih A, García A, Lenoir C, Monnier J, Perrot JL, Puig S, Rubegni P, Skowron F, Suppa M, Tognetti L, Venturini M, Malvehy J. Understanding the anatomy of dermoscopy of melanocytic skin tumours: Correlation in vivo with line-field optical coherence tomography. J Eur Acad Dermatol Venereol 2024; 38:1191-1201. [PMID: 38131528 DOI: 10.1111/jdv.19771] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2023] [Accepted: 11/21/2023] [Indexed: 12/23/2023]
Abstract
BACKGROUND Early melanoma detection is the main factor affecting prognosis and survival. For that reason, non-invasive technologies have been developed to provide a more accurate diagnosis. Recently, line-field confocal optical coherence tomography (LC-OCT) was developed to provide an in vivo, imaging device, with deep penetration and cellular resolution in three dimensions. Combining the advantages of conventional OCT and reflectance confocal microscopy, this tool seems to be particularly suitable for melanocytic lesions. OBJECTIVES The objective of this study was to identify and describe the correlation between specific dermoscopic criteria and LC-OCT features in three dimensions associated with melanocytic lesions. METHODS Dermoscopic and LC-OCT images of 126 melanocytic lesions were acquired in three different centres. The following dermoscopic criteria have been considered: reticular pattern, dots and globules, structureless areas, blue-whitish veil, regression structures, negative network, homogeneous pattern, streaks and blotches. RESULTS 69 (55%) benign and 57 (45%) malignant lesions were analysed. A regular reticular pattern was found associated in the 75% of the cases with the presence of elongated rete ridges with pigmented cells along the basal layer, while atypical reticular pattern showed an irregular organization of rete ridges with melanocytic hyperplasia, broadened and fused ridges and elongated nests. Both typical and atypical dots and globules were found associated with melanocytic nests in the dermis or at the dermoepidermal junction (DEJ), as well as with keratin cysts/pseudocysts. Grey globules corresponded to the presence of melanin-containing dermal inflammatory cells (melanophages) within the papillae. Structureless brown/black areas correlated with alterations of the DEJ. We observed the same DEJ alterations, but with the presence of dermal melanophages, in 36% of the cases of blue/white/grey structureless areas. A description of each LC-OCT/dermoscopy correlation was made. CONCLUSIONS LC-OCT permitted for the first time to perform an in vivo, 3D correlation between dermoscopic criteria and pathological-like features of melanocytic lesions.
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Affiliation(s)
- S Soglia
- Melanoma Unit, Dermatology Department, Hospital Clínic de Barcelona, Barcelona, Spain
- Department of Dermatology, University of Brescia, Brescia, Italy
| | - J Pérez-Anker
- Melanoma Unit, Dermatology Department, Hospital Clínic de Barcelona, Barcelona, Spain
| | - R Albero
- Pathology Department, Hospital Clinic, University of Barcelona, Barcelona, Spain
| | - L Alós
- Pathology Department, Hospital Clinic, University of Barcelona, Barcelona, Spain
| | - V Berot
- Dermatology Department, University Hospital of Saint-Etienne, Saint-Etienne, France
| | - P Castillo
- Pathology Department, Hospital Clinic, University of Barcelona, Barcelona, Spain
| | - E Cinotti
- Dermatology Unit, Department of Medical, Surgical and Neurological Sciences, University of Siena, Siena, Italy
- Groupe d'Imagerie Cutanée Non Invasive (GICNI) of the Société Française de Dermatologie, Paris, France
| | - V Del Marmol
- Department of Dermatology, Hôpital Erasme, HUB, Université Libre de Bruxelles, Brussels, Belgium
| | - A Fakih
- Dermatology Department, University Hospital of Saint-Etienne, Saint-Etienne, France
| | - A García
- Pathology Department, Hospital Clinic, University of Barcelona, Barcelona, Spain
| | - C Lenoir
- Department of Dermatology, Hôpital Erasme, HUB, Université Libre de Bruxelles, Brussels, Belgium
| | - J Monnier
- Dermatology Department, AP-HM, Aix-Marseille University, Marseille, France
| | - J L Perrot
- Dermatology Department, University Hospital of Saint-Etienne, Saint-Etienne, France
- Groupe d'Imagerie Cutanée Non Invasive (GICNI) of the Société Française de Dermatologie, Paris, France
- Laboratoire de tribologie des systèmes UMR CNRS 5513, Saint-Etienne, France
| | - S Puig
- Melanoma Unit, Dermatology Department, Hospital Clínic de Barcelona, Barcelona, Spain
- Universitat de Barcelona, Barcelona, Spain
- IDIBAPS, Barcelona, Belgium
| | - P Rubegni
- Dermatology Unit, Department of Medical, Surgical and Neurological Sciences, University of Siena, Siena, Italy
| | - F Skowron
- Dermatology Department, University Hospital of Saint-Etienne, Saint-Etienne, France
| | - M Suppa
- Groupe d'Imagerie Cutanée Non Invasive (GICNI) of the Société Française de Dermatologie, Paris, France
- Department of Dermatology, Hôpital Erasme, HUB, Université Libre de Bruxelles, Brussels, Belgium
- Department of Dermato-Oncology, Institut Jules Bordet, HUB, Université Libre de Bruxelles, Brussels, Belgium
| | - L Tognetti
- Dermatology Unit, Department of Medical, Surgical and Neurological Sciences, University of Siena, Siena, Italy
| | - M Venturini
- Department of Dermatology, University of Brescia, Brescia, Italy
| | - J Malvehy
- Melanoma Unit, Dermatology Department, Hospital Clínic de Barcelona, Barcelona, Spain
- Universitat de Barcelona, Barcelona, Spain
- IDIBAPS, Barcelona, Belgium
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Laser treatment of benign melanocytic lesion: a review. Lasers Med Sci 2022; 37:3353-3362. [PMID: 36097230 DOI: 10.1007/s10103-022-03642-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Accepted: 09/06/2022] [Indexed: 10/14/2022]
Abstract
Treatment of pigmented lesions is one of the major challenges of laser and cosmetic practitioners. The most common pigmented lesions that are treated by lasers are melanocytic nevi, ephelides, solar lentigines, and café au lait macules. Melanin absorbs different wavelengths (500-1100 nm); thereby, treatment of various pigmented lesions requires the application of lasers with different wavelengths. Choosing the most appropriate type of laser depends on various factors such as the chromophore and the location of a specific lesion in the skin. In this paper, we aim to review the most efficient laser treatment protocols for each pigmented skin lesion and compare their efficacy in each part based on the previous studies.
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Wang YK, Gao YJ, Liu J, Zhu QL, Wang JC, Qin J, Jin HZ. A comparative study of melanocytic nevi classification with dermoscopy and high-frequency ultrasound. Skin Res Technol 2021; 28:265-273. [PMID: 34865255 PMCID: PMC9907694 DOI: 10.1111/srt.13123] [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: 06/26/2021] [Accepted: 10/16/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Melanocytic nevi (MN) can be classified into three subtypes according to the depth of the nests of nevus cells which is important for management. High-frequency ultrasound (HF-US) can clearly reveal the lesion size, contour, depth, and internal structures. However, the HF-US studies of MN according to subtypes are limited. We aimed to describe the HF-US features of MN and explore its value in accurate classification. MATERIALS AND METHODS This retrospective study was conducted from January 2018 to November 2019. Eighty-five patients with MN were included and examined by 50 and 20 MHz HF-US. The HF-US features were recorded including morphological flatness, depth, shape, boundary, internal echogenicity, hyperechoic spots, lateral acoustic shadow, posterior echoic patterns, mushroom signs, and straw-hat signs. Each image was evaluated by two physicians independently, and the consistency was tested. RESULTS Eleven lesions could not be detected by HF-US. The rest 74 lesions underwent ultrasonic analysis. MN appeared as strip-shaped or oval, hypoechoic areas localized in the epidermis and dermis under ultrasonography. A strong consistency between HF-US and dermoscopy of determining the lesion depth was achieved (κ = 0.935, p < 0.001). The hyperechoic spots were found in 57.6% intradermal nevi. The mushroom signs were seen in 34.8% intradermal nevi, and the straw-hat signs were seen in all the compound nevi. CONCLUSION MN can be correctly classified using HF-US, and it had a strong correlation with dermoscopic and clinical classification. HF-US could further reveal the internal morphological features of MN, which may support more precise classification and management.
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Affiliation(s)
- Yu-Kun Wang
- Department of Dermatology, Peking Union Medical College Hospital, Center for Translational Medicine, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yuan-Jing Gao
- Department of Ultrasound, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Center for Translational Medicine, Beijing, China
| | - Jie Liu
- Department of Dermatology, Peking Union Medical College Hospital, Center for Translational Medicine, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Qing-Li Zhu
- Department of Ultrasound, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Center for Translational Medicine, Beijing, China
| | - Jun-Cheng Wang
- Department of Dermatology, Peking Union Medical College Hospital, Center for Translational Medicine, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jing Qin
- Department of Ultrasound, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Center for Translational Medicine, Beijing, China
| | - Hong-Zhong Jin
- Department of Dermatology, Peking Union Medical College Hospital, Center for Translational Medicine, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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Campos-do-Carmo G, Nobre AB, Cuzzi T, Argenziano G, Ferreira CG, Thuler LCS. Melanocytic lesions ≤ 6mm: Prospective series of 481 melanocytic trunk and limb lesions in Brazil. PLoS One 2021; 16:e0252162. [PMID: 34101726 PMCID: PMC8186794 DOI: 10.1371/journal.pone.0252162] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Accepted: 05/11/2021] [Indexed: 11/19/2022] Open
Abstract
Early diagnosis when melanoma is still small and thin is essential for improving mortality and morbidity. However, the diagnosis of small size melanoma might be particularly difficult, not only clinically but also dermoscopically. This study aimed to define clinical and dermatoscopic parameters in the diagnosis of suspicious pigmented cutaneous lesions with a diameter of ≤ 6mm and determine the sensitivity, specificity, positive and negative predictive values as well as the accuracy of each clinical and dermatoscopic criterion. This is a transversal, descriptive and analytical study of dermatoscopic analysis with the gold standard being the pathologic examination obtained from the excisional biopsy of suspicious melanocytic lesions with a diameter of ≤ 6mm. Trunk and limb lesion data from a public health service and a private clinic were prospectively collected from 2011 to 2017 by a unique observer. In total, 481 melanocytic lesions were included, with 73.8% being ≤ 4mm in diameter. Overall, 123 were diagnosed as melanoma, 56.0% in situ and 22.0% as thin melanomas (Breslow index 0.1 to 1.0mm). Melanoma presented symmetry in 53.7% of cases, regular borders in 54.5% and a single color in 60.2%. Regarding evolution, 13.8% of melanomas versus 10.9% of benign lesions (p = 0.116) were new by comparing photos from baseline with photos from the follow-up. The majority of melanomas (65%) were found on the limbs compared to 37.2% of the benign lesions at this location (p<0.001). A multiple logistic regression model adjusted for age, gender and location was created. The independent variables associated with the diagnosis of melanoma ≤ 6mm, adjusted for age, gender and location, were: streaks (adjusted Odds Ratio [aOR] 2.5; 95% CI 1.3-4.7; p = 0.006), and the presence of a structureless area (aOR 2.2, 95% CI 1.2-4.0, p = 0.011). Conversely, a symmetric typical pigment network was a protection variable (aOR 0.4, 95% 0.7-0.9, p = 0.040). In conclusion, dermatoscopic criteria have been identified which help to diagnose cases of small size melanoma. These include streaks and structureless areas that can be taken, particularly in consideration for the diagnosis of this subset of small difficult melanomas.
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Ribero S, Zugna D, Spector T, Bataille V. Natural history of naevi: a two‐wave study. Br J Dermatol 2021; 184:289-295. [DOI: 10.1111/bjd.19171] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/28/2020] [Indexed: 12/27/2022]
Affiliation(s)
- S. Ribero
- Department of Twin Research and Genetic Epidemiology King's College London London UK
- Dermatology Clinic University of TurinTurin Italy
| | - D. Zugna
- Section of Statistics Department of Medical Sciences University of Turin Turin Italy
| | - T. Spector
- Department of Twin Research and Genetic Epidemiology King's College London London UK
| | - V. Bataille
- Department of Twin Research and Genetic Epidemiology King's College London London UK
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Gaydina TA, Dvornikova EG. Efficacy of smartphone-compatible optical instrument for assessing melanocytic nevi for malignancy. BULLETIN OF RUSSIAN STATE MEDICAL UNIVERSITY 2020. [DOI: 10.24075/brsmu.2020.065] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Early detection of melanocytic nevus progression to malignant melanoma is a pressing concern. Traditionally, patients with multiple melanocytic nevi (MMN) are monitored for extended periods of time and excisional biopsies are performed on individual suspicious melanocytic nevi (MN). This approach is costly and tremendously time-consuming for both doctors and patients. The aim of this study was to evaluate the efficacy of a smartphone-compatible optical instrument in the assessment of MN for malignancy. Seven patients aged 43 to 65 years with MMN on the trunk and upper/lower extremities were followed-up for 4 years. Dermoscopy images of MN were taken and analyzed using a Handyscope smartphone-compatible optical system operated at 20x magnification and a Handyscope3 application. A total of 74 MN were surgically removed during the follow-up period. None of the patients had melanoma. The results of dermoscopy image analysis generated by the convolutional neural network coincided with histopathology findings in all cases. The optical Handyscope system demonstrated its efficacy in assessing MN for malignancy. AI can be used for primary screening of MMN dermoscopy images. However, histopathological verification of the diagnosis is still needed.
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Affiliation(s)
- TA Gaydina
- Pirogov Russian National Research Medical University, Moscow, Russia
| | - EG Dvornikova
- Pirogov Russian National Research Medical University, Moscow, Russia
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Zalaudek I, Conforti C, Guarneri F, Vezzoni R, Deinlein T, Hofmann-Wellenhof R, Longo C, Moscarella E, Kittler H, Argenziano G, Giuffrida R. Clinical and dermoscopic characteristics of congenital and noncongenital nevus-associated melanomas. J Am Acad Dermatol 2020; 83:1080-1087. [PMID: 32360715 DOI: 10.1016/j.jaad.2020.04.120] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Revised: 04/23/2020] [Accepted: 04/23/2020] [Indexed: 02/03/2023]
Abstract
BACKGROUND No specific features of nevus-associated melanoma (NAM) are currently defined. OBJECTIVE To identify clinical/dermoscopic features of NAM. METHODS Retrospective evaluation of histopathologically diagnosed NAM. RESULTS Eighty of 165 NAMs had a clinically recognizable nevus component, often raised or nodular, most frequently characterized by different morphologic clones and/or colors. In 111 of 165 NAMs, dermoscopy showed a nevus component, prevalently characterized by regular dots/clods and structureless brown areas. Clinically, the melanoma component was eccentric/peripheral in 45 of 80 cases and central in 35 of 80; dermoscopically, the figures were 59 of 111 and 52 of 111, respectively. Melanomas associated with congenital nevi (C-NAMs) occur at a younger age and have a thicker Breslow depth than melanomas associated with acquired nevi (NC-NAMs). Dermoscopically, regular dots/globules characterize C-NAMs, and hypopigmented structureless areas characterize NC-NAMs. LIMITATIONS Retrospective analysis. CONCLUSION C-NAMs are more often central to a congenital nevus, with a clod/globular or structureless brown pattern, typical of young patients. NC-NAMs are frequently hypopigmented nodules/plaques, eccentric/peripheral, with hypopigmented structureless areas, typical of older patients.
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Affiliation(s)
- Iris Zalaudek
- Department of Dermatology and Venereology, University of Trieste, Ospedale Maggiore, Trieste, Italy
| | - Claudio Conforti
- Department of Dermatology and Venereology, University of Trieste, Ospedale Maggiore, Trieste, Italy
| | - Fabrizio Guarneri
- Department of Clinical and Experimental Medicine, Section of Dermatology, University of Messina, Messina, Italy
| | - Roberta Vezzoni
- Department of Dermatology and Venereology, University of Trieste, Ospedale Maggiore, Trieste, Italy
| | - Teresa Deinlein
- Department of Dermatology and Venereology, Medical University of Graz, Graz, Austria
| | | | - Caterina Longo
- Department of Dermatology, University of Modena and Reggio Emilia, Modena, Italy; Centro Oncologico ad Alta Tecnologia Diagnostica, Azienda Unità Sanitaria Locale- Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) di Reggio Emilia, Reggio Emilia, Italy
| | - Elvira Moscarella
- Dermatology Unit, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Harald Kittler
- Department of Dermatology, Medical University of Vienna, Vienna, Austria
| | | | - Roberta Giuffrida
- Department of Clinical and Experimental Medicine, Section of Dermatology, University of Messina, Messina, Italy.
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An intuitive explanation of dermoscopic structures by digitally reconstructed pathological horizontal top-down view images. Sci Rep 2019; 9:19875. [PMID: 31882764 PMCID: PMC6934765 DOI: 10.1038/s41598-019-56522-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2019] [Accepted: 12/12/2019] [Indexed: 02/08/2023] Open
Abstract
Dermoscopy is a convenient tool to diagnose melanocytic lesions, especially nevus and melanoma. Various pigmented structures, including pigment network, dots and globules, and streaks, are observed in dermoscopy. Usually, 2D vertical images are used to explain the correlation of dermoscopy and histopathology. However, because the image of dermoscopy is horizontal, it is difficult for the horizontal view of dermoscopy to refer to the vertical view of histopathology. In our study, we digitally reconstructed 2D horizontal top-down view images and 3D aerial images from 50–100 serial 2D vertical sections by using high-speed scanner and 3D software in 6 cases of melanocytic lesion. Our new technology intuitively explained the histopathological structures corresponding to the dermoscopic structures. This technique could be used as a good educational tool for beginners.
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Kasuya A, Aoshima M, Fukuchi K, Shimauchi T, Fujiyama T, Tokura Y. Digitally reconstructed top‐down view images provide intuitive understanding of the correlation between dermoscopy and histopathology: a good educational tool. Br J Dermatol 2019; 181:606-607. [DOI: 10.1111/bjd.17819] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Affiliation(s)
- A. Kasuya
- Department of Dermatology Hamamatsu University School of Medicine Hamamatsu Japan
| | - M. Aoshima
- Department of Dermatology Hamamatsu University School of Medicine Hamamatsu Japan
| | - K. Fukuchi
- Department of Dermatology Hamamatsu University School of Medicine Hamamatsu Japan
| | - T. Shimauchi
- Department of Dermatology Hamamatsu University School of Medicine Hamamatsu Japan
| | - T. Fujiyama
- Department of Dermatology Hamamatsu University School of Medicine Hamamatsu Japan
| | - Y. Tokura
- Department of Dermatology Hamamatsu University School of Medicine Hamamatsu Japan
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Yélamos O, Braun RP, Liopyris K, Wolner ZJ, Kerl K, Gerami P, Marghoob AA. Dermoscopy and dermatopathology correlates of cutaneous neoplasms. J Am Acad Dermatol 2019; 80:341-363. [DOI: 10.1016/j.jaad.2018.07.073] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2018] [Revised: 07/01/2018] [Accepted: 07/04/2018] [Indexed: 12/21/2022]
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Abstract
PURPOSE OF REVIEW Prognosis of patients with advanced melanoma is dismal with a median overall survival of about 8 months and 5-year overall survival from a diagnosis of metastatic disease of roughly 10%. However, immune checkpoint inhibitors have brought indispensable benefits to melanoma patients. Here we will review the recent clinical efficacy and adverse events of immune checkpoint inhibitors for melanoma patients. RECENT FINDINGS The immune checkpoint inhibitors increase confirmed objective response and prolong progression-free and overall survival of the afflicted patients in association with maintaining their quality of life. Although diverse immune-related adverse events occur, most of them are manageable by appropriate immunomodulating agents. Clinical efficacy of immune checkpoint inhibitors continues even after discontinuation of drugs. Compared with conventional therapeutic options, the immune checkpoint inhibitors appear to prolong the survival of patients with advanced melanoma. Further clinical trials are warranted to determine whether their combinatory use with other treatment options may augment benefits or not.
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