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Nazir ZH, Hussain K, Marghoob AA, Patel NP. Ancillary techniques to improve dermoscopy specificity for skin cancer detection. Clin Exp Dermatol 2023; 48:167-174. [PMID: 36763719 DOI: 10.1093/ced/llac065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Revised: 11/02/2022] [Accepted: 11/03/2022] [Indexed: 01/22/2023]
Abstract
Although the use of dermoscopy has markedly improved both the sensitivity and specificity for skin cancer detection, there is still opportunity for improvement. Ancillary techniques provide additional ways to assess a lesion with the aim of improving our diagnostic ability with little extra cost. Usage of these techniques can strengthen diagnosis and help reduce unnecessary biopsies of benign lesions.
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Affiliation(s)
- Zaeem H Nazir
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Khawar Hussain
- Department of Dermatology, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - Ashfaq A Marghoob
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Neil P Patel
- Department of Dermatology, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK
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2
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Di Matteo E, Pampena R, Pizzichetta MA, Cinotti E, Chester J, Kaleci S, Manfredini M, Guida S, Dika E, Moscarella E, Lallas A, Apalla Z, Argenziano G, Perrot JL, Tognetti L, Lai M, Cantisani C, Roberti V, Fiorani D, Baraldi C, Veneziano L, Papageorgiou C, Ciardo S, Rubegni P, Zalaudek I, Patrizi A, Longo C, Bianchi L, Pellacani G, Farnetani F. Unusual Dermoscopic Patterns of Basal Cell Carcinoma Mimicking Melanoma. Exp Dermatol 2022; 31:890-898. [PMID: 35102605 PMCID: PMC9305787 DOI: 10.1111/exd.14533] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2021] [Revised: 12/23/2021] [Accepted: 01/27/2022] [Indexed: 12/25/2022]
Abstract
Background Basal cell carcinoma can simulate melanoma and specific dermoscopic criteria have not yet been defined in a large cohort. Objective To identify dermoscopic “trump” characteristics for differential diagnosis, identify cluster groups and assess the clinical impact of this study's findings. Methods Retrospective, multicentric comparative study of atypical, non‐facial basal cell carcinoma (≥1 seven‐point checklist criteria) and melanoma (with at least one BCC criteria) at dermoscopy. Observed dermoscopic features were used to develop a proposed score. Lesion clusters were defined with hierarchical analysis. Clinical impact was assessed with a blinded reader study following this study's results. Results A total of 146 basal cell carcinoma and 76 melanoma were included. Atypical vascular pattern was common to most lesions (74.5%). Twelve trump features were included in the proposed score (sensitivity 94.1% and specificity 79.5%). Cluster analysis identified 3 basal cell carcinoma and 3 melanoma clusters. Findings improved overall diagnostic accuracy and confidence (26.8% and 13.8%, respectively; p < 0.001). Conclusions These findings support the notion that atypical vascular pattern should be considered a shared feature of both melanoma and atypical basal cell carcinoma. Our proposed score improves diagnostic accuracy and confidence. Absence of pigmented features was associated with lower diagnostic accuracy and confidence.
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Affiliation(s)
- Eleonora Di Matteo
- Dermatologic Unit, Department of Systems Medicine, University of Rome Tor Vergata, 00133, Rome, Italy.,Department of Dermatology, University of Modena and Reggio Emilia, Modena, Italy
| | - Riccardo Pampena
- Centro Oncologico ad Alta Tecnologia Diagnostica, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Maria A Pizzichetta
- Division Medical Oncology and Preventive Oncology, National Cancer Institute, Aviano, Italy.,Dermatology Clinic, Maggiore Hospital, University of Trieste, Trieste, Italy
| | - Elisa Cinotti
- Department of Medical, Surgical and Neurological Science, Dermatology Section, University of Siena, S. Maria Alle Scotte Hospital, Viale Bracci 16, Siena, 53100, Italy
| | - Johanna Chester
- Department of Dermatology, University of Modena and Reggio Emilia, Modena, Italy
| | - Shaniko Kaleci
- Department of Dermatology, University of Modena and Reggio Emilia, Modena, Italy
| | - Marco Manfredini
- Department of Dermatology, University of Modena and Reggio Emilia, Modena, Italy
| | - Stefania Guida
- Department of Dermatology, University of Modena and Reggio Emilia, Modena, Italy
| | - Emi Dika
- Dermatology, IRCCS di Policlinico Sant'Orsola Hospital, Bologna, Italy.,Dermatology Section, Department of Experimental, Diagnostic and Specialty Medicine, DIMES, University of Bologna, 40138, Bologna, Italy
| | - Elvira Moscarella
- Dermatology Unit, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Aimilios Lallas
- First Department of Dermatology, School of Medicine, Aristotle University, Thessaloniki, Greece
| | - Zoe Apalla
- Second Department of Dermatology, School of Medicine, Aristotle University, Thessaloniki, Greece
| | | | - Jian L Perrot
- Department of Dermatology, University Hospital of Saint-Etienne, Saint-Etienne Cedex 2 42055, France
| | - Linda Tognetti
- Department of Medical, Surgical and Neurological Science, Dermatology Section, University of Siena, S. Maria Alle Scotte Hospital, Viale Bracci 16, Siena, 53100, Italy
| | - Michela Lai
- Department of Dermatology, University of Modena and Reggio Emilia, Modena, Italy.,Centro Oncologico ad Alta Tecnologia Diagnostica, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Carmen Cantisani
- Dermatology Clinic, Department of Clinical Internal, Anesthesiological and Cardiovascular Sciences, Sapienza University of Rome, Rome, Italy
| | - Vincenzo Roberti
- Dermatology Clinic, Department of Clinical Internal, Anesthesiological and Cardiovascular Sciences, Sapienza University of Rome, Rome, Italy
| | - Diletta Fiorani
- Department of Medical, Surgical and Neurological Science, Dermatology Section, University of Siena, S. Maria Alle Scotte Hospital, Viale Bracci 16, Siena, 53100, Italy
| | - Carlotta Baraldi
- Dermatology, IRCCS di Policlinico Sant'Orsola Hospital, Bologna, Italy.,Dermatology Section, Department of Experimental, Diagnostic and Specialty Medicine, DIMES, University of Bologna, 40138, Bologna, Italy
| | - Leonardo Veneziano
- Dermatology, IRCCS di Policlinico Sant'Orsola Hospital, Bologna, Italy.,Dermatology Section, Department of Experimental, Diagnostic and Specialty Medicine, DIMES, University of Bologna, 40138, Bologna, Italy
| | - Chryssoula Papageorgiou
- Second Department of Dermatology, School of Medicine, Aristotle University, Thessaloniki, Greece
| | - Silvana Ciardo
- Department of Dermatology, University of Modena and Reggio Emilia, Modena, Italy
| | - Pietro Rubegni
- Department of Medical, Surgical and Neurological Science, Dermatology Section, University of Siena, S. Maria Alle Scotte Hospital, Viale Bracci 16, Siena, 53100, Italy
| | - Iris Zalaudek
- Dermatology Clinic, Maggiore Hospital, University of Trieste, Trieste, Italy
| | - Annalisa Patrizi
- Dermatology, IRCCS di Policlinico Sant'Orsola Hospital, Bologna, Italy.,Dermatology Section, Department of Experimental, Diagnostic and Specialty Medicine, DIMES, University of Bologna, 40138, Bologna, Italy
| | - Caterina Longo
- Department of Dermatology, University of Modena and Reggio Emilia, Modena, Italy.,Centro Oncologico ad Alta Tecnologia Diagnostica, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Luca Bianchi
- Dermatologic Unit, Department of Systems Medicine, University of Rome Tor Vergata, 00133, Rome, Italy
| | - Giovanni Pellacani
- Department of Dermatology, University of Modena and Reggio Emilia, Modena, Italy.,Dermatology Clinic, Department of Clinical Internal, Anesthesiological and Cardiovascular Sciences, Sapienza University of Rome, Rome, Italy
| | - Francesca Farnetani
- Department of Dermatology, University of Modena and Reggio Emilia, Modena, Italy
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3
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Massone C, Hofman-Wellenhof R, Chiodi S, Sola S. Dermoscopic Criteria, Histopathological Correlates and Genetic Findings of Thin Melanoma on Non-Volar Skin. Genes (Basel) 2021; 12:1288. [PMID: 34440462 PMCID: PMC8391530 DOI: 10.3390/genes12081288] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Revised: 08/19/2021] [Accepted: 08/19/2021] [Indexed: 11/23/2022] Open
Abstract
Dermoscopy is a non-invasive, in vivo technique that allows the visualization of subsurface skin structures in the epidermis, at the dermoepidermal junction, and in the upper dermis. Dermoscopy brought a new dimension in evaluating melanocytic skin neoplasms (MSN) also representing a link between clinical and pathologic examination of any MSN. However, histopathology remains the gold standard in diagnosing MSN. Dermoscopic-pathologic correlation enhances the level of quality of MSN diagnosis and increases the level of confidence of pathologists. Melanoma is one of the most genetically predisposed among all cancers in humans. The genetic landscape of melanoma has been described in the last years but is still a field in continuous evolution. Melanoma genetic markers play a role not only in melanoma susceptibility, initiation, and progression but also in prognosis and therapeutic decisions. Several studies described the dermoscopic specific criteria and predictors for melanoma and their histopathologic correlates, but only a few studies investigated the correlation among dermoscopy, pathology, and genetic of MSN. The aim of this work is to review the published data about dermoscopic features of melanoma, their histopathological correlates with regards also to genetic alterations. Particularly, this review will focus on low-CSD (cumulative sun damage) melanoma or superficial spreading melanoma, high-CSD melanoma, and nevus-associated melanoma.
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Affiliation(s)
| | | | | | - Simona Sola
- Surgical Pathology, Galliera Hospital, 16128 Genoa, Italy;
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4
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Williams NM, Rojas KD, Reynolds JM, Kwon D, Shum-Tien J, Jaimes N. Assessment of Diagnostic Accuracy of Dermoscopic Structures and Patterns Used in Melanoma Detection: A Systematic Review and Meta-analysis. JAMA Dermatol 2021; 157:1078-1088. [PMID: 34347005 DOI: 10.1001/jamadermatol.2021.2845] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Importance Dermoscopy increases the diagnostic accuracy for melanoma. However, the accuracy of individual structures and patterns used in melanoma detection has not been systematically evaluated. Objective To assess the diagnostic accuracy of individual dermoscopic structures and patterns used in melanoma detection. Data Sources A search of Ovid Medline, Embase, Cochrane CENTRAL, Scopus, and Web of Science was conducted from inception to July 2020. Study Selection Studies evaluating the dermoscopic structures and patterns among melanomas in comparison with nonmelanoma lesions were included. Excluded were studies with fewer than 3 patients, studies in languages other than English or Spanish, studies not reporting dermoscopic structures per lesion type, and studies assessing only nail, mucosal, acral, facial, or metastatic melanomas or melanomas on chronically sun-damaged skin. Multiple reviewers applied these criteria, and 0.7% of studies met selection criteria. Data Extraction and Synthesis The Preferred Reporting Items for Systematic Reviews and Meta-analyses reporting guideline and Meta-analysis of Observational Studies in Epidemiology reporting guideline were followed. Guidelines were applied via independent extraction by multiple observers. Data were pooled using a random-effects model. Main Outcomes and Measures The prespecified outcome measures were diagnostic accuracy (sensitivity and specificity) and risk (odds ratio [OR]) of melanoma for the following dermoscopic structures/patterns: atypical dots/globules, atypical network, blue-white veil, negative network, off-centered blotch, peripheral-tan structureless areas, atypical vessels (eg, linear irregular, polymorphous), pseudopods, streaks, regression (ie, peppering, scarlike areas), shiny white structures, angulated lines, irregular pigmentation, and a multicomponent pattern. Results A total of 40 studies including 22 796 skin lesions and 5736 melanomas were evaluated. The structures and patterns with the highest ORs were shiny white structures (OR, 6.7; 95% CI, 2.5-17.9), pseudopods (OR, 6.7; 95% CI, 2.7-16.1), irregular pigmentation (OR, 6.4; 95% CI, 2.0-20.5), blue-white veil (OR, 6.3; 95% CI, 3.7-10.7), and peppering (OR, 6.3; 95% CI, 2.4-16.1). The structures with the highest specificity were pseudopods (97.3%; 95% CI, 94.3%-98.7%), shiny white structures (93.6%; 95% CI, 85.6%-97.3%), peppering (93.4%; 95% CI, 81.9%-97.8%), and streaks (92.1%; 95% CI, 88.4%-94.7%), whereas features with the highest sensitivity were irregular pigmentation (62.3%; 95% CI, 31.2%-85.8%), blue-white veil (60.6%; 95% CI, 46.7%-72.9%), atypical network (56.8%; 95% CI, 43.6%-69.2%), and a multicomponent pattern (53.7%; 95% CI, 40.4%-66.4%). Conclusions and Relevance The findings of this systematic review and meta-analysis support the diagnostic importance of dermoscopic structures associated with melanoma detection (eg, shiny white structures, blue-white veil), further corroborate the importance of the overall pattern, and may suggest a hierarchy in the significance of these structures and patterns.
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Affiliation(s)
- Natalie M Williams
- Dr Phillip Frost Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, Florida
| | - Kristina D Rojas
- Dr Phillip Frost Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, Florida
| | - John M Reynolds
- Department of Health Informatics, Calder Memorial Library, University of Miami Miller School of Medicine, Miami, Florida
| | - Deukwoo Kwon
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, Florida
| | - Jackie Shum-Tien
- Dr Phillip Frost Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, Florida
| | - Natalia Jaimes
- Dr Phillip Frost Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, Florida.,Sylvester Comprehensive Cancer Center, University of Miami Health System, Miami, Florida
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5
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Trindade FM, de Freitas MLP, Bittencourt FV. Dermoscopic evaluation of superficial spreading melanoma. An Bras Dermatol 2021; 96:139-147. [PMID: 33637398 PMCID: PMC8007484 DOI: 10.1016/j.abd.2020.06.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Accepted: 06/28/2020] [Indexed: 11/08/2022] Open
Abstract
Background Dermoscopy increases the sensitivity of the diagnosis of melanoma, leading to its early identification and increasing the chances of cure. Objective To describe the clinical and dermoscopic characteristics of superficial spreading melanomas, and to detect the differences between in situ and invasive 1-mm thick melanomas. Methods This was a cross-sectional study in which dermoscopic images of 58 melanomas, grouped according to their thickness, were evaluated. Results 24 in situ melanomas were evaluated, 28 invasive melanomas with Breslow ≤ 1 mm (0.50 ± 0.22 mm) and six with Breslow > 1 mm (2.35 ± 2.02 mm). In situ melanomas were smaller than invasive melanomas. The most commonly found dermoscopic criteria were asymmetry (84.5%), three or more colors (81.0%), and atypical network (79.3%). A non-specific pattern was more common in in situ melanomas (p = 0.028) and atypical network in invasive melanomas with Breslow 1 mm presented inverted network (p = 0.018). Study limitations The sample was selected by convenience, since it was necessary to have a preoperative photo of the tumor, which may have led to the loss of clinically less significant lesions, as well as those highly suggestive of melanoma. Conclusions Melanomas in early stages showed a more frequent nonspecific pattern and atypical network, while invasive melanomas showed a multicomponent pattern, three or more colors, and an inverted network.
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Affiliation(s)
| | | | - Flávia Vasques Bittencourt
- Dermatology Service, Hospital das Clínicas, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
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6
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Bañuls J, Francés L, Niveiro M, Juan G, Schneller-Pavelescu L, Illán F, Sánchez-Payá J, Nagore E, Moreno I, Lallas A, Zaballos P. Heterogeneity in the linear shiny white structures in melanomas seen with polarized light according to histopathological association: Cross-sectional observational study in 118 cutaneous melanomas. J Dermatol 2020; 47:1058-1062. [PMID: 32537762 DOI: 10.1111/1346-8138.15457] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Revised: 04/29/2020] [Accepted: 05/11/2020] [Indexed: 11/28/2022]
Abstract
Polarized dermoscopy enables visualization of linear shiny white structures in melanomas, thought to be due to the existence of fibrosis in the dermis. Our objective was to establish the existence of two types of linear shiny white structures and assess their association with different histological structures. We performed a cross-sectional study including all non-acral, non-facial melanomas from our hospital with linear shiny white structures. The outcome variable was the type of linear shiny white structures: shiny white streaks and white strands. We evaluated their association with explanatory variables that may affect the reflectance of melanomas and Breslow index. We used χ2 statistics and also calculated the sensitivity and specificity of each linear shiny white structure to predict those variables. We detected linear shiny white structures in 118 melanomas. Regarding shiny white streaks, we only found a statistically significant positive relationship with fibrosis in the papillary dermis. Regarding white strands, we found statistically significant and positive relationships with hyperkeratosis, Breslow index of 0.8 mm or more and acanthosis. Sensitivity and specificity study revealed that the presence of shiny white streaks was the most sensitive (81.7%) and specific (72.3%) for fibrosis in the papillary dermis, and presence of white strands was the most sensitive (91.1%) and specific (85.7%) for hyperkeratosis.
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Affiliation(s)
- José Bañuls
- Dermatology Department, Hospital General Universitario de Alicante, Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL), Alicante, Spain.,Dermatology Area, Clinical Medicine Department, University Miguel Hernandez, Sant Joan de Alicante, Spain
| | - Laura Francés
- Dermatology Department, Hospital Vinalopó, Elche, Spain
| | - Maria Niveiro
- Pathology Department, Hospital General Universitario de Alicante, Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL), Alicante, Spain
| | - Gloria Juan
- Dermatology Department, Hospital General Universitario de Alicante, Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL), Alicante, Spain
| | - Luca Schneller-Pavelescu
- Dermatology Department, Hospital General Universitario de Alicante, Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL), Alicante, Spain
| | - Francisco Illán
- Pathology Department, Hospital General Universitario de Alicante, Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL), Alicante, Spain
| | - José Sánchez-Payá
- Epidemiology Unit, Preventive Medicine Department, Hospital General Universitario de Alicante, Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL), Alicante, Spain
| | - Eduardo Nagore
- Department of Dermatology, Instituto Valenciano de Oncología, Valencia, Spain.,Universidad Católica de Valencia San Vicente Mártir, Valencia, Spain
| | - Ignacio Moreno
- Department of Materials Science, Optics and Electronic Technology, University Miguel Hernandez, Elche, Spain
| | - Aimilios Lallas
- First Department of Dermatology, Aristotle University, Thessaloniki, Greece
| | - Pedro Zaballos
- Dermatology Department, Hospital Sant Pau i Santa Tecla, Tarragona, Spain
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7
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Shi K, Kim D, Mohan LS, Garfield EM, Quan VL, Zhang B, Panah E, Compres EV, Khan AU, Gerami P. A retrospective cohort study of the diagnostic value of different subtypes of atypical pigment network on dermoscopy. J Am Acad Dermatol 2020; 83:1028-1034. [PMID: 32446823 DOI: 10.1016/j.jaad.2020.05.080] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Revised: 05/12/2020] [Accepted: 05/16/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND Atypical network encompasses several patterns. Few studies assess the sensitivity, specificity, and positive and negative predictive values of network subtypes. OBJECTIVE We assessed the diagnostic value of atypical network subtypes and their histopathologic correlates in cutaneous melanocytic lesions. METHODS A retrospective search (2014-2018) from a high-risk melanoma clinic for cases scored for atypical network with accompanying dermoscopic photographs yielded 120 lesions (15 melanoma; 30 severely, 38 moderately, and 32 mildly atypical nevi; 4 compound nevi; and 1 junctional nevus). A dermatopathologist blinded to diagnosis assessed dermoscopic and histologic features. Network abnormality correlates with histopathology and clinical diagnoses were assessed with sensitivity, specificity, positive and negative predictive values, and odds ratios. RESULTS A multivariable model with shiny white streaks (odds ratio 3.02) and inverse network (OR 4.46) was most predictive of melanoma or severe atypia. Positive predictive value for melanoma or severe atypia in decreasing order was inverse network (73.9%), shiny white streaks (71.4%), loss of network (46%), branched streaks (29.4%), and thick brown lines (28.4%). LIMITATIONS Cases were retrospectively found from a pigmented lesion clinic and evaluated by a single dermatopathologist. CONCLUSION Shiny white streaks and inverse network are most predictive of melanoma or severe atypia and warrant biopsy if found on dermoscopy.
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Affiliation(s)
- Katherine Shi
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Daniel Kim
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Lauren S Mohan
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Erin M Garfield
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Victor L Quan
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Bin Zhang
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Elnaz Panah
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Elsy V Compres
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Ayesha U Khan
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Pedram Gerami
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois; Robert H. Lurie Cancer Center, Feinberg School of Medicine, Northwestern University, Chicago, Illinois.
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8
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Corneli P, Zalaudek I, Magaton Rizzi G, di Meo N. Improving the early diagnosis of early nodular melanoma: can we do better? Expert Rev Anticancer Ther 2018; 18:1007-1012. [DOI: 10.1080/14737140.2018.1507822] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Affiliation(s)
- Paola Corneli
- Dermatology Clinic, Maggiore Hospital, University of Trieste, Trieste, Italy
| | - Iris Zalaudek
- Dermatology Clinic, Maggiore Hospital, University of Trieste, Trieste, Italy
| | | | - Nicola di Meo
- Dermatology Clinic, Maggiore Hospital, University of Trieste, Trieste, Italy
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9
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Armengot-Carbó M, Nagore E, García-Casado Z, Botella-Estrada R. The association between dermoscopic features and BRAF mutational status in cutaneous melanoma: Significance of the blue-white veil. J Am Acad Dermatol 2018; 78:920-926.e4. [DOI: 10.1016/j.jaad.2017.12.064] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2017] [Revised: 12/20/2017] [Accepted: 12/24/2017] [Indexed: 10/18/2022]
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10
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Cavicchini S, Guanziroli E, Del Gobbo A, Scaparro M, Gianotti R. Neurothekeoma, a hard to diagnose neoplasm among red nodules. Australas J Dermatol 2018. [PMID: 29527669 DOI: 10.1111/ajd.12800] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Affiliation(s)
- Stefano Cavicchini
- Department of Pathophysiology and Transplantation, Dermatology Unit, IRCCS Foundation, Cà Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Elena Guanziroli
- Department of Pathophysiology and Transplantation, University of Milan, IRCCS Foundation, Cà Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Alessandro Del Gobbo
- Division of Pathology, IRCCS Foundation, Cà Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Manuela Scaparro
- Department of Pathophysiology and Transplantation, Dermatology Unit, IRCCS Foundation, Cà Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Raffaele Gianotti
- Department of Pathophysiology and Transplantation, University of Milan, IRCCS Foundation, Cà Granda Ospedale Maggiore Policlinico, Milan, Italy
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11
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Verzi AE, Quan VL, Walton KE, Martini MC, Marghoob AA, Garfield EM, Kong BY, Isales MC, VandenBoom T, Zhang B, West DP, Gerami P. The diagnostic value and histologic correlate of distinct patterns of shiny white streaks for the diagnosis of melanoma: A retrospective, case-control study. J Am Acad Dermatol 2017; 78:913-919. [PMID: 29138058 DOI: 10.1016/j.jaad.2017.11.021] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2017] [Revised: 10/24/2017] [Accepted: 11/02/2017] [Indexed: 11/25/2022]
Abstract
BACKGROUND Shiny white streaks (SWSs) are best visualized with polarized dermoscopy and correlate with dermal fibroplasia histopathologically. SWSs have been described at higher frequencies in melanomas than in benign nevi. OBJECTIVE We assessed the diagnostic value of different patterns of SWSs and their histologic correlate in melanocytic lesions. METHODS Polarized dermoscopic images of 1507 histopathologically diagnosed melanocytic neoplasms were analyzed for presence and pattern of SWSs. Histology was also reviewed for correlation. RESULTS Among 1507 melanocytic neoplasms, SWSs were observed in 31 of 144 melanomas (22%) and 22 of 1363 benign neoplasms (1.6%) (P < .001). The sensitivity and specificity of SWSs for melanoma were 22% and 98%, respectively. Diffuse SWSs exhibited the greatest diagnostic value for melanoma, with sensitivity of 11.8% and specificity of 99.5%. Focal central and peripheral SWSs were comparable in diagnostic significance. The presence of SWSs was highly uncommon in dysplastic nevi, whereas in certain benign subgroups of nevi such as Spitz nevi and atypical genital special site nevi, SWSs were not uncommon. Diffuse SWSs correlated with greater breadth of deep fibroplasia than focal SWSs (P = .009), and SWSs correlated with greater Breslow depth among melanomas (P = .007). LIMITATIONS This study was retrospective. CONCLUSION Polarized dermoscopy is a valuable diagnostic tool in the identification of SWSs, a feature that is highly specific for melanoma.
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Affiliation(s)
- Anna Eliza Verzi
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Victor L Quan
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Kara E Walton
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Mary C Martini
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Ashfaq A Marghoob
- Dermatology Service, Memorial Sloan Kettering Cancer Center, Hauppage, New York, New York
| | - Erin M Garfield
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Betty Y Kong
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Maria Cristina Isales
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Timothy VandenBoom
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Bin Zhang
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Dennis P West
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Pedram Gerami
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois.
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Kittler H, Marghoob AA, Argenziano G, Carrera C, Curiel-Lewandrowski C, Hofmann-Wellenhof R, Malvehy J, Menzies S, Puig S, Rabinovitz H, Stolz W, Saida T, Soyer HP, Siegel E, Stoecker WV, Scope A, Tanaka M, Thomas L, Tschandl P, Zalaudek I, Halpern A. Standardization of terminology in dermoscopy/dermatoscopy: Results of the third consensus conference of the International Society of Dermoscopy. J Am Acad Dermatol 2016; 74:1093-106. [PMID: 26896294 DOI: 10.1016/j.jaad.2015.12.038] [Citation(s) in RCA: 173] [Impact Index Per Article: 21.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2015] [Revised: 12/15/2015] [Accepted: 12/20/2015] [Indexed: 10/22/2022]
Abstract
BACKGROUND Evolving dermoscopic terminology motivated us to initiate a new consensus. OBJECTIVE We sought to establish a dictionary of standardized terms. METHODS We reviewed the medical literature, conducted a survey, and convened a discussion among experts. RESULTS Two competitive terminologies exist, a more metaphoric terminology that includes numerous terms and a descriptive terminology based on 5 basic terms. In a survey among members of the International Society of Dermoscopy (IDS) 23.5% (n = 201) participants preferentially use descriptive terminology, 20.1% (n = 172) use metaphoric terminology, and 484 (56.5%) use both. More participants who had been initially trained by metaphoric terminology prefer using descriptive terminology than vice versa (9.7% vs 2.6%, P < .001). Most new terms that were published since the last consensus conference in 2003 were unknown to the majority of the participants. There was uniform consensus that both terminologies are suitable, that metaphoric terms need definitions, that synonyms should be avoided, and that the creation of new metaphoric terms should be discouraged. The expert panel proposed a dictionary of standardized terms taking account of metaphoric and descriptive terms. LIMITATIONS A consensus seeks a workable compromise but does not guarantee its implementation. CONCLUSION The new consensus provides a revised framework of standardized terms to enhance the consistent use of dermoscopic terminology.
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Affiliation(s)
- Harald Kittler
- Department of Dermatology, Medical University of Vienna, Vienna, Austria.
| | - Ashfaq A Marghoob
- Dermatology Service, Memorial Sloan-Kettering Cancer Center, New York, New York
| | - Giuseppe Argenziano
- Dermatology and Skin Cancer Unit, Arcispedale Santa Maria Nuova, Istituto di Ricerca e Cura a Carattere Scientifico (IRCCS), Reggio Emilia, Italy
| | - Cristina Carrera
- Melanoma Unit, Department of Dermatology, Hospital Clinic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, and Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBER ER), Instituto de Salud Carlos III, Barcelona, Spain
| | | | - Rainer Hofmann-Wellenhof
- Department of Dermatology and Venerology, Nonmelanoma Skin Cancer Unit, Medical University of Graz, Graz, Austria
| | - Josep Malvehy
- Melanoma Unit, Department of Dermatology, Hospital Clinic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, and Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBER ER), Instituto de Salud Carlos III, Barcelona, Spain
| | - Scott Menzies
- Sydney Melanoma Diagnostic Center, Sydney Cancer Center, Royal Prince Alfred Hospital, Camperdown, Australia
| | - Susana Puig
- Melanoma Unit, Department of Dermatology, Hospital Clinic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, and Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBER ER), Instituto de Salud Carlos III, Barcelona, Spain
| | | | - Wilhelm Stolz
- Department of Dermatology, Klinikum München, Munich, Germany
| | - Toshiaki Saida
- Department of Dermatology, Shinshu University School of Medicine, Matsumoto, Japan
| | - H Peter Soyer
- Dermatology Research Center, University of Queensland, School of Medicine, Translational Research Institute, Brisbane, Australia
| | - Eliot Siegel
- University of Maryland Medical Center, Baltimore Department of Veterans Affairs Medical Center, Baltimore, Maryland
| | - William V Stoecker
- Department of Dermatology, University of Missouri Health Sciences Center, Columbia, Missouri
| | - Alon Scope
- Dermatology Service, Memorial Sloan-Kettering Cancer Center, New York, New York; Department of Dermatology, Sheba Medical Center and Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Masaru Tanaka
- Department of Dermatology, Keio University, Tokyo, Japan
| | - Luc Thomas
- Service de Dermatologie, Center Hospitalier Universitaire de Lyon, Lyon, France
| | - Philipp Tschandl
- Department of Dermatology, Medical University of Vienna, Vienna, Austria
| | - Iris Zalaudek
- Department of Dermatology and Venerology, Nonmelanoma Skin Cancer Unit, Medical University of Graz, Graz, Austria
| | - Allan Halpern
- Dermatology Service, Memorial Sloan-Kettering Cancer Center, New York, New York
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13
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Lake A, Jones B. Dermoscopy: to cross-polarize, or not to cross-polarize, that is the question. J Vis Commun Med 2015. [DOI: 10.3109/17453054.2015.1046371] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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14
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Suppa M, Micantonio T, Di Stefani A, Soyer HP, Chimenti S, Fargnoli MC, Peris K. Dermoscopic variability of basal cell carcinoma according to clinical type and anatomic location. J Eur Acad Dermatol Venereol 2015; 29:1732-41. [PMID: 25627865 DOI: 10.1111/jdv.12980] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2014] [Accepted: 12/21/2014] [Indexed: 12/01/2022]
Abstract
BACKGROUND Correctly diagnosing basal cell carcinoma (BCC) clinical type is crucial for the therapeutic management. A systematic description of the variability of all reported BCC dermoscopic features according to clinical type and anatomic location is lacking. OBJECTIVES To describe the dermoscopic variability of BCC according to clinical type and anatomic location and to test the hypothesis of a clinical/dermoscopic continuum across superficial BCCs (sBCCs) with increasing palpability. METHODS Clinical/dermoscopic images of nodular BCCs (nBCCs) and sBCCs with different degrees of palpability were retrospectively evaluated for the presence of dermoscopic criteria including degree of pigmentation, BCC-associated patterns, diverse vascular patterns, melanocytic patterns and polarized light patterns. RESULTS We examined 501 histopathologically proven BCCs (66.9% sBCCs; 33.1% nBCCs), mainly located on trunk (46.7%; mostly sBCCs) and face (30.5%; mostly nBCCs). Short fine telangiectasias, leaf-like areas, spoke-wheel areas, small erosions and concentric structures were significantly associated with sBCC, whereas arborizing telangiectasias, blue-white veil-like structures, white shiny areas and rainbow pattern with nBCCs. Short fine telangiectasia, spoke-wheel areas and small erosions were independently associated with trunk location, whereas arborizing telangiectasias with facial location. Scalp BCCs had significantly more pigmentation and melanocytic criteria than BCCs located elsewhere. Multiple clinical/dermoscopic parameters displayed a significant linear trend across increasingly palpable sBCCs. CONCLUSIONS Particular dermoscopic criteria are independently associated with clinical type and anatomic location of BCC. Heavily pigmented, scalp BCCs are the most challenging to diagnose. A clinical/dermoscopic continuum across increasingly palpable sBCCs was detected and could be potentially important for the non-surgical management of the disease.
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Affiliation(s)
- M Suppa
- Department of Dermatology, University of L'Aquila, L'Aquila, Italy.,Department of Dermatology, Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium
| | - T Micantonio
- Department of Dermatology, University of L'Aquila, L'Aquila, Italy
| | - A Di Stefani
- Division of Dermatology, Complesso Integrato Columbus, Rome, Italy
| | - H P Soyer
- Dermatology Research Centre, The University of Queensland, School of Medicine, Translational Research Institute, Brisbane, QLD, Australia
| | - S Chimenti
- Department of Dermatology, University of Rome Tor Vergata, Rome, Italy
| | - M C Fargnoli
- Department of Dermatology, University of L'Aquila, L'Aquila, Italy
| | - K Peris
- Department of Dermatology, Catholic University of the Sacred Heart, Rome, Italy
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Negative pigment network and shiny white streaks: a dermoscopic-pathological correlation study. Am J Dermatopathol 2014; 36:433-8. [PMID: 24803064 DOI: 10.1097/dad.0000000000000019] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
It has been suggested that both negative pigment network (NPN) and shiny white streaks (SWS) were related to an increase of dermal collagen. To study precisely the dermoscopic-histopathologic correlation of NPN and SWS, we have performed a dermoscopic-pathological correlation study. A total of 25 skin lesions dermoscopically characterized by the presence of NPN and/or SWS, including histopathologically confirmed dermatofibroma (2), Spitz nevus (3), compound nevus (6), dysplastic nevus (7), and melanoma (7), were evaluated for the presence of NPN, SWS, and blue-white veil. The histopathologic features such as orthokeratosis, orthokeratosis plus nests of pigmented melanocytes at the junction, hypergranulosis, hypergranulosis plus nests of pigmented melanocytes at the junction, epidermal invagination plus orthokeratosis, fibrosis, lamellar fibrosis, and elongation and bridging of rete ridges were evaluated. We found a disagreement in 80% of skin lesions between NPN and fibrosis (P = 0.02). For SWS, a significant agreement emerged with hypergranulosis (76%; P = 0.01), and the same occurred with fibrosis (80%; P = 0.01). Moreover, blue-white veil also displayed a significant agreement with hypergranulosis (68%; P = 0.04). Our findings confirm the correlation of SWS with fibrosis, whereas a clear-cut histopathologic substrate of NPN could not be established.
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16
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Crignis GSND, Abreu LD, Buçard AM, Barcaui CB. Polarized dermoscopy of mammary Paget disease. An Bras Dermatol 2014; 88:290-2. [PMID: 23739693 PMCID: PMC3750901 DOI: 10.1590/s0365-05962013000200023] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2011] [Accepted: 05/04/2012] [Indexed: 11/21/2022] Open
Abstract
Mammary Paget's disease is a rare intraepithelial adenocarcinoma, located on the nipple/areola complex, highly associated with breast cancer. Although the international literature emphasizes the dermatoscopic pattern of mammary Paget's disease pigmented variant, the authors describe the dermoscopic findings of classical Paget's disease and demonstrate the presence of chrysalis-like structures, criteria recently described in the literature and not yet reported in Paget's disease.
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González-Álvarez T, Armengot-Carbó M, Barreiro A, Alarcón I, Carrera C, García A, Malvehy J, Puig S. Dermoscopic rosettes as a clue for pigmented incipient melanoma. Dermatology 2013; 228:31-3. [PMID: 24356536 DOI: 10.1159/000356822] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2013] [Accepted: 10/28/2013] [Indexed: 11/19/2022] Open
Abstract
The rosette structure is a dermoscopic sign visible under polarized light, characterized by 4 white points arranged as a 4-leaf clover. It has been mainly described in facial sun-damaged skin and actinic keratosis, although it has also been found in squamous and basal cell carcinomas, and in 2 cases of hypomelanotic melanomas. We describe 2 different cases of pigmented incipient melanomas with the presence of multiple rosettes and shiny white structures on dermoscopy. In the reflectance confocal microscope they exhibit a disarranged epidermal architecture with atypical and dendritic cells. Histological examination showed focal hyperkeratosis and a normal corneal layer presented alternatively. To our knowledge this is the first description of rosette structures in pigmented melanomas. Based on a proper dermoscopic- confocal-histopathological correlation, we hypothesize that rosettes could correspond to optic phenomena due to changes in the superficial epidermal reaction and in the acrosyringia.
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Affiliation(s)
- Tatiana González-Álvarez
- Dermatology Department, Melanoma Unit, Hospital Clínic and Institut d'Investigacions Biomèdiques August Pi i Sunyer, Barcelona University, Barcelona, Spain
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18
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“White” network in Spitz nevi and early melanomas lacking significant pigmentation. J Am Acad Dermatol 2013; 69:56-60. [DOI: 10.1016/j.jaad.2012.12.974] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2012] [Revised: 12/18/2012] [Accepted: 12/24/2012] [Indexed: 11/20/2022]
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19
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Pizzichetta MA, Talamini R, Marghoob AA, Soyer HP, Argenziano G, Bono R, Corradin MT, De Giorgi V, Gonzalez MA, Kolm I, Kopf AW, Malvehy J, Nami N, Oliviero M, Pellacani G, Puig S, Rabinovitz H, Rubegni P, Seidenari S, Stanganelli I, Veronesi A, Zalaudek I, Zampieri P, Menzies SW. Negative pigment network: an additional dermoscopic feature for the diagnosis of melanoma. J Am Acad Dermatol 2012; 68:552-559. [PMID: 23062610 DOI: 10.1016/j.jaad.2012.08.012] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2011] [Revised: 07/23/2012] [Accepted: 08/09/2012] [Indexed: 10/27/2022]
Abstract
BACKGROUND The negative pigment network (NPN) is seen as a negative of the pigmented network and it is purported to be a melanoma-specific structure. OBJECTIVES We sought to assess the frequency, sensitivity, specificity, and odds ratios (ORs) of NPN between melanoma cases and a group of control lesions. METHODS Digitalized images of skin lesions from 679 patients with histopathological diagnosis of dermatofibroma (115), melanocytic nevus (220), Spitz nevus (139), and melanoma (205) were retrospectively collected and blindly evaluated to assess the presence/absence of NPN. RESULTS The frequency of occurrence of NPN was higher in the melanoma group (34.6%) than in Spitz nevus (28.8%), melanocytic nevus (18.2%), and dermatofibroma (11.3%) groups. An OR of 1.8 emerged for the diagnosis of melanoma in the presence of NPN as compared with nonmelanoma diagnosis. Conversely, for melanocytic nevi and dermatofibromas the OR was very low (0.5 and 0.3, respectively). For Spitz nevi the OR of 1.1 was not statistically significant. When comparing melanoma with dermatofibroma, melanocytic nevus, and Spitz nevus, we observed a significantly higher frequency of multicomponent pattern (68.1%), asymmetric pigmentation (92.9%), irregularly distributed NPN (87.3%), and peripheral location of NPN (66.2%) in melanomas. LIMITATIONS Further studies can provide the precise dermoscopic-histopathologic correlation of NPN in melanoma and other lesions. CONCLUSIONS The overall morphologic pattern of NPN, such as the irregular distribution and the peripheral location of NPN, along with the multicomponent pattern and the asymmetric pigmentation could be used as additional features in distinguishing melanoma from Spitz nevus and other benign lesions.
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Affiliation(s)
| | - Renato Talamini
- Centro di Riferimento Oncologico, National Cancer Institute, Aviano, Italy
| | - Ash A Marghoob
- Dermatology Section, Memorial Sloan Kettering Cancer Center, New York, New York
| | - H Peter Soyer
- Dermatology Research Center, University of Queensland, School of Medicine, Princess Alexandra Hospital, Brisbane, Australia
| | - Giuseppe Argenziano
- Dermatology and Skin Cancer Unit, Arcispedale Santa Maria Nuova, Istituto di Ricovero e Cura a Carattere Scientifico(IRCCS), Reggio Emilia, Italy
| | | | | | | | | | - Isabel Kolm
- Department of Dermatology, University of Miami, Miami, Florida
| | - Andrew W Kopf
- New York University School of Medicine, New York, New York
| | - Joseph Malvehy
- Melanoma Unit, Department of Dermatology, Hospital Clinic, Institut d'Investigacions Biomediques August Pi i Sunyer, Barcelona, Spain
| | - Niccolò Nami
- Department of Dermatology, University of Siena, Siena, Italy
| | | | - Giovanni Pellacani
- Department of Dermatology, University of Modena and Reggio Emilia, Modena and Reggio Emilia, Italy
| | - Susana Puig
- Melanoma Unit, Department of Dermatology, Hospital Clinic, Institut d'Investigacions Biomediques August Pi i Sunyer, Barcelona, Spain
| | | | - Pietro Rubegni
- Department of Dermatology, University of Siena, Siena, Italy
| | - Stefania Seidenari
- Department of Dermatology, University of Modena and Reggio Emilia, Modena and Reggio Emilia, Italy
| | | | - Andrea Veronesi
- Centro di Riferimento Oncologico, National Cancer Institute, Aviano, Italy
| | | | | | - Scott W Menzies
- Sydney Melanoma Diagnostic Center, Royal Prince Alfred Hospital and Discipline of Dermatology, University of Sydney, Sydney, Australia
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Jaimes N, Halpern JA, Puig S, Malvehy J, Myskowski PL, Braun RP, Marghoob AA. Dermoscopy: An Aid to the Detection of Amelanotic Cutaneous Melanoma Metastases. Dermatol Surg 2012; 38:1437-44. [DOI: 10.1111/j.1524-4725.2012.02438.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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21
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The significance of crystalline/chrysalis structures in the diagnosis of melanocytic and nonmelanocytic lesions. J Am Acad Dermatol 2012; 67:194.e1-8. [DOI: 10.1016/j.jaad.2011.04.039] [Citation(s) in RCA: 64] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2011] [Revised: 04/07/2011] [Accepted: 04/20/2011] [Indexed: 11/17/2022]
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Abstract
Chrysalis, also named shiny white streaks, are white, linear structures only visible with polarized dermoscopy. They have been reported in several tumors included melanomas and Spitz nevi, and their histological substrate is believed to be dermal fibrosis. We have performed a correlation study between the dermoscopic and the histopathological features of 9 Spitz nevi. Chrysalis were present in 4 Spitz nevi (44%) and in all of them there was a high degree of fibroplasia. In one case, chrysalis, evident at the center of the lesion, progressively merged with negative pigment network at the periphery. We suggest that chrysalis and negative pigment network are manifestations of the same histopathological finding: increased collagen occurring at different levels of the dermis.
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Gulia A, Massone C. Advances in dermoscopy for detecting melanocytic lesions. F1000 MEDICINE REPORTS 2012; 4:11. [PMID: 22719794 PMCID: PMC3370664 DOI: 10.3410/m4-11] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Over the last 30 years dermatological approaches to diagnosis and management of melanocytic lesions have been revolutionized by the introduction of dermoscopy. Continuous improvements are being made in applying the technique, mostly in melanoma diagnosis, follow-up of melanocytic lesions and nevogenesis. Identification of new dermoscopic criteria, such as the dermoscopic island and the blue-black color for thin and nodular melanoma, respectively, further add two new weapons in the dermoscopical armamentarium for diagnosis of otherwise featureless melanoma. Recent advances show that short-term, 3-month, follow-up is the optimum time interval to identify minimal changes in initially featureless melanomas. Nevertheless, long-term follow-up is still useful for the recognition of changes in melanomas with a very low-rate of growth. Dermoscopy greatly improves diagnosis and early excision of melanomas and reduces the number of unnecessary excisions.
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Affiliation(s)
- Andrea Gulia
- Department of Dermatology, University of L’AquilaL’AquilaItaly
- Department of Dermatology, Medical University of GrazGraz, Auenbruggerplatz 8, A-8036 GrazAustria
| | - Cesare Massone
- Department of Dermatology, Medical University of GrazGraz, Auenbruggerplatz 8, A-8036 GrazAustria
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25
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Vascularización en dermatoscopia. ACTAS DERMO-SIFILIOGRAFICAS 2012; 103:357-75. [DOI: 10.1016/j.ad.2011.11.005] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2011] [Revised: 11/02/2011] [Accepted: 11/06/2011] [Indexed: 11/19/2022] Open
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26
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Arnold SJ, Bowling JCR. ‘Shiny white streaks’ in lichen amyloidosis: A clue to diagnosis. Australas J Dermatol 2012; 53:272-3. [DOI: 10.1111/j.1440-0960.2011.00871.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Liebman TN, Rabinovitz HS, Dusza SW, Marghoob AA. White shiny structures: dermoscopic features revealed under polarized light. J Eur Acad Dermatol Venereol 2011; 26:1493-7. [PMID: 22035217 DOI: 10.1111/j.1468-3083.2011.04317.x] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND White shiny structures, including white shiny lines, white shiny areas and rosettes, are features only observed under polarized dermoscopy (PD). OBJECTIVE To evaluate the prevalence of the varied morphologies of white shiny structures in melanoma, basal cell carcinoma (BCC), squamous cell carcinoma (SCC), actinic keratosis (AK) and lichen planus-like keratosis (LPLK). METHODS Retrospective study using dermoscopic images of biopsy-proven melanoma, BCC, SCC, AK and LPLK. RESULTS A total of 538 lesions were assessed under PD. One or more types of white shiny structures were observed in 38.7% of study lesions (208/538). BCCs were significantly more likely to display a combination of white shiny areas and white shiny lines (short lines and/or ill-defined strands) (31.9%; 61/191) than any other lesions (P<0.001). BCC were more likely than other lesions to have white shiny lines distributed without any organized pattern (P<0.001). Lines in melanoma were significantly more likely than other lesion types to be oriented orthogonally (P<0.001). When white shiny lines were present, melanomas were significantly more likely than other lesions to exhibit short discrete white lines (P<0.001). Rosettes were significantly more likely to be observed in actinic tumours than other lesions (P<0.001). CONCLUSION The presence of white shiny lines of any length accompanied by white shiny areas is most suggestive of a diagnosis of BCC (P<0.001). Melanomas are more likely to display short white shiny lines in an orthogonal distribution (P<0.001) and without white shiny areas. Actinic tumours are most likely to exhibit rosettes (P<0.001).
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Affiliation(s)
- T N Liebman
- Memorial Sloan-Kettering Cancer Center, New York, NY, USA
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28
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Jaimes N, Braun R, Thomas L, Marghoob A. Clinical and dermoscopic characteristics of amelanotic melanomas that are not of the nodular subtype. J Eur Acad Dermatol Venereol 2011; 26:591-6. [DOI: 10.1111/j.1468-3083.2011.04122.x] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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