1
|
Licata G, Brancaccio G, Ronchi A, Borsari S, Longo C, Piana S, Cinotti E, Dragotto M, Rubegni P, Argenziano G, Moscarella E. Is reflectance confocal microscopy useful in the differential diagnosis of extra facial lentigo maligna? A retrospective multicentric case-control study. J Eur Acad Dermatol Venereol 2023; 37:2474-2480. [PMID: 37478292 DOI: 10.1111/jdv.19379] [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: 04/12/2023] [Accepted: 06/28/2023] [Indexed: 07/23/2023]
Abstract
BACKGROUND Extra facial lentigo maligna (EF-LM) arises outside the head and neck area. EF-LM presents the classic histological features of lentigo maligna. The dermoscopic aspects of EF-LM have been poorly studied. OBJECTIVE The primary aims of our study were to analyse and describe the clinical, dermoscopic and confocal microscopy features of a series of histologically confirmed EF-LM. METHOD We conducted a retrospective and multicentric study. From our database, we selected 48 cases of thin melanomas on photodamaged skin with histological features of EF-LM of which clinical, dermoscopic and confocal microscopy images were available, and a control group of 45 lesions, that can be subjected to differential diagnosis such as solar lentigo, lichenoid keratosis, seborrheic keratosis and melanocytic nevi, of which dermoscopic and confocal microscope images were available. RESULTS Extra facial lentigo maligna had a higher prevalence of lentigo-like pigment patterns, angulated lines and zigzag structures. At confocal microscopy, LM-EF cases showed a higher prevalence of pagetoid spreading, round cells, dendritic cells in the epidermis, atypical cells at the dermo-epidermal junction, dendritic cells at the junction, meshwork pattern and elastosis. Our study shows that reflectance confocal microscopy (RCM) has a sensitivity of 90% and a specificity of 97% for the differential diagnosis of this type of melanoma. CONCLUSIONS Extra facial lentigo maligna does not have the classic dermoscopic features of superficial spreading melanoma, the most observed dermoscopic criteria are angulated lines and lentigo-like pigment patterns without lentigo-like border. RCM can be a valuable imaging tool for the evaluation of all those suspicion skin lesions at dermoscopy highlighting cellular atypia suggestive for melanoma.
Collapse
Affiliation(s)
- Gaetano Licata
- Dermatology Unit, San Antonio Abate Hospital, Trapani, Italy
| | - Gabriella Brancaccio
- Dermatology Unit, Department of Mental and Physical Health and Preventive Medicine, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Andrea Ronchi
- Division of Pathology, Department of Mental and Physical Health and Preventive Medicine, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Stefania Borsari
- Centro Oncologico ad Alta Tecnologia Diagnostica, Azienda Unità Sanitaria Locale - IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Caterina Longo
- Centro Oncologico ad Alta Tecnologia Diagnostica, Azienda Unità Sanitaria Locale - IRCCS di Reggio Emilia, Reggio Emilia, Italy
- Dermatology Clinic, University of Modena and Reggio Emilia, Modena, Italy
| | - Simonetta Piana
- Pathology Unit, Azienda Unità Sanitaria Locale - IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Elisa Cinotti
- Dermatology Unit, Department of Medical, Surgical and Neurological Sciences, University of Siena, Siena, Italy
| | - Martina Dragotto
- Dermatology Unit, Department of Medical, Surgical and Neurological Sciences, University of Siena, Siena, Italy
| | - Pietro Rubegni
- Dermatology Unit, Department of Medical, Surgical and Neurological Sciences, University of Siena, Siena, Italy
| | - Giuseppe Argenziano
- Dermatology Unit, Department of Mental and Physical Health and Preventive Medicine, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Elvira Moscarella
- Dermatology Unit, Department of Mental and Physical Health and Preventive Medicine, University of Campania Luigi Vanvitelli, Naples, Italy
| |
Collapse
|
2
|
Tognetti L, Cartocci A, Żychowska M, Savarese I, Cinotti E, Pizzichetta MA, Moscarella E, Longo C, Farnetani F, Guida S, Paoli J, Lallas A, Tiodorovic D, Stanganelli I, Magi S, Dika E, Zalaudek I, Suppa M, Argenziano G, Pellacani G, Perrot JL, Miracapillo C, Rubegni G, Cevenini G, Rubegni P. A risk-scoring model for the differential diagnosis of lentigo maligna and other atypical pigmented facial lesions of the face: The facial iDScore. J Eur Acad Dermatol Venereol 2023; 37:2301-2310. [PMID: 37467376 DOI: 10.1111/jdv.19360] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Accepted: 07/07/2023] [Indexed: 07/21/2023]
Abstract
BACKGROUND Due to progressive ageing of the population, the incidence of facial lentigo maligna (LM) of the face is increasing. Many benign simulators of LM and LMM, known as atypical pigmented facial lesions (aPFLs-pigmented actinic keratosis, solar lentigo, seborrheic keratosis, seborrheic-lichenoid keratosis, atypical nevus) may be found on photodamaged skin. This generates many diagnostic issues and increases the number of biopsies, with a subsequent impact on aesthetic outcome and health insurance costs. OBJECTIVES Our aim was to develop a risk-scoring classifier-based algorithm to estimate the probability of an aPFL being malignant. A second aim was to compare its diagnostic accuracy with that of dermoscopists so as to define the advantages of using the model in patient management. MATERIALS AND METHODS A total of 154 dermatologists analysed 1111 aPFLs and their management in a teledermatology setting: They performed pattern analysis, gave an intuitive clinical diagnosis and proposed lesion management options (follow-up/reflectance confocal microscopy/biopsy). Each case was composed of a dermoscopic and/or clinical picture plus metadata (histology, age, sex, location, diameter). The risk-scoring classifier was developed and tested on this dataset and then validated on 86 additional aPFLs. RESULTS The facial Integrated Dermoscopic Score (iDScore) model consisted of seven dermoscopic variables and three objective parameters (diameter ≥ 8 mm, age ≥ 70 years, male sex); the score ranged from 0 to 16. In the testing set, the facial iDScore-aided diagnosis was more accurate (AUC = 0.79 [IC 95% 0.757-0.843]) than the intuitive diagnosis proposed by dermatologists (average of 43.5%). In the management study, the score model reduced the number of benign lesions sent for biopsies by 41.5% and increased the number of LM/LMM cases sent for reflectance confocal microscopy or biopsy instead of follow-up by 66%. CONCLUSIONS The facial iDScore can be proposed as a feasible tool for managing patients with aPFLs.
Collapse
Affiliation(s)
- Linda Tognetti
- Dermatology Unit, Department of Medical, Surgical and Neurosciences, University of Siena, Siena, Italy
| | - Alessandra Cartocci
- Dermatology Unit, Department of Medical, Surgical and Neurosciences, University of Siena, Siena, Italy
- Department of Medical Biotechnologies, University of Siena, Siena, Italy
| | - Magdalena Żychowska
- Department of Dermatology, Institute of Medical Sciences, Medical College of Rzeszow University, Rzeszów, Poland
| | - Imma Savarese
- Soc Dermatologia Pistoia-Prato, USL Toscana Centro, Pistoia, Italy
| | - Elisa Cinotti
- Dermatology Unit, Department of Medical, Surgical and Neurosciences, University of Siena, Siena, Italy
| | - Maria Antonietta Pizzichetta
- Dermatology Clinic, Ospedale di Trieste, Trieste, Italy
- Department of Medical Oncology, Centro di Riferimento Oncologico di Aviano (CRO), IRCCS, Aviano, Italy
| | - Elvira Moscarella
- Dermatology Unit, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Caterina Longo
- Centro Oncologico ad Alta Tecnologia Diagnostica, Azienda Unità Sanitaria Locale, IRCCS di Reggio Emilia, Reggio Emilia, Italy
- Department of Dermatology, University of Modena and Reggio Emilia, Modena, Italy
| | - Francesca Farnetani
- Department of Dermatology, University of Modena and Reggio Emilia, Modena, Italy
| | - Stefania Guida
- Vita-Salute San Raffaele University, Milan, Italy
- Dermatology Clinic, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - John Paoli
- Department of Dermatology and Venereology, Institute of Clinical Sciences, Sahlgrenska Academy, Sahlgrenska University Hospital, University of Gothenburg, Gothenburg, Sweden
- Department of Dermatology and Venereology, Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Aimilios Lallas
- First Department of Dermatology, Aristotle University, Thessaloniki, Greece
| | | | - Ignazio Stanganelli
- Skin Cancer Unit, Scientific Institute of Romagna for the Study of Cancer, IRCCS, IRST, Meldola, Italy
- Department of Dermatology, University of Parma, Parma, Italy
| | - Serena Magi
- Skin Cancer Unit, Scientific Institute of Romagna for the Study of Cancer, IRCCS, IRST, Meldola, Italy
| | - Emi Dika
- Dermatology Unit, Department of Experimental, Diagnostic and Specialty Medicine (DIMES), University of Bologna, Bologna, Italy
- Dermatology, IRCCS Azienda Ospedaliero Universitaria di Bologna, Bologna, Italy
| | - Iris Zalaudek
- Dermatology Clinic, Ospedale di Trieste, Trieste, Italy
| | - Mariano Suppa
- Department of Dermatology, Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium
- Groupe d'Imagerie Cutanée Non-Invasive, Société Française de Dermatologie, Paris, France
- Department of Dermatology, Institut Jules Bordet, Brussels, Belgium
| | | | - Giovanni Pellacani
- Department of Dermatology, Policlinico Umberto I, University of Rome La Sapienza, Rome, Italy
| | - Jean Luc Perrot
- Dermatology Unit, University Hospital of St-Etienne, Saint Etienne, France
| | - Chiara Miracapillo
- Dermatology Unit, Department of Medical, Surgical and Neurosciences, University of Siena, Siena, Italy
| | - Giovanni Rubegni
- Department of Ophthalmology, University of Catania, Catania, Italy
| | - Gabriele Cevenini
- Bioengineering and Biomedical Data Science Lab, Department of Medical Biotechnologies, University of Siena, Siena, Italy
| | - Pietro Rubegni
- Dermatology Unit, Department of Medical, Surgical and Neurosciences, University of Siena, Siena, Italy
| |
Collapse
|
3
|
Punchihewa N, Wee E, Kelly JW, Mclean C, Mar VJ, Pan Y. The anatomical distribution of lentiginous melanoma (lentigo maligna and lentigo maligna melanoma): Differences according to sex. Australas J Dermatol 2023; 64:e277-e280. [PMID: 37078498 DOI: 10.1111/ajd.14058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Revised: 03/25/2023] [Accepted: 04/03/2023] [Indexed: 04/21/2023]
Affiliation(s)
- Nisal Punchihewa
- Department of Medicine, Eastern Health, Box Hill, Victoria, Australia
| | - Edmund Wee
- Victorian Melanoma Service, Alfred Hospital, Melbourne, Victoria, Australia
| | - John W Kelly
- Victorian Melanoma Service, Alfred Hospital, Melbourne, Victoria, Australia
| | - Catriona Mclean
- Victorian Melanoma Service, Alfred Hospital, Melbourne, Victoria, Australia
| | - Victoria J Mar
- Victorian Melanoma Service, Alfred Hospital, Melbourne, Victoria, Australia
| | - Yan Pan
- Victorian Melanoma Service, Alfred Hospital, Melbourne, Victoria, Australia
| |
Collapse
|
4
|
Ferhatoglu F, Erturk K, Faruk T. Cutaneous melanoma survival rates of the elderly are not worse than those of the young, yet they have some specific differences. J Cancer Res Ther 2022; 19:S0. [PMID: 37147952 DOI: 10.4103/jcrt.jcrt_815_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Introduction The incidence of cutaneous melanoma among the elderly has increased significantly. Unfavorable survival rates are associated with insufficient patient managements and poor prognostic features in the elderly. We aimed to compare elderly (≥75 years) and younger (<75 years) patients with cutaneous melanoma to determine the differences and the prognostic significance of age. Materials and Methods The retrospective data of 117 elderly and 232 younger patients with cutaneous melanoma were compared. Results The median age of the elderly patients was 78 years (75-104), and 51.3% of the patients were female. Of the patients, 14.5% were in the metastatic stages. Clinicopathologic factors such as extremity melanomas (P = 0.01), Clark levels IV-V (P = 0.04), ulceration (P = 0.009), and neurotropism (P = 0.03) were significantly more common in elderly patients. However, BRAF mutation was significantly more common in younger patients (P = 0.003). Overall survival (OS) and recurrence-free survival (RFS) rates of both the groups were similar. Lymph node involvement (P < 0.005), distant metastasis (P < 0.005), and relapse of disease (P = 0.02) were associated with poor OS in elderly patients. Tumor-infiltrating lymphocytes was associated with prolonged RFS (P = 0.05), while extremity melanomas (P = 0.01), lymphovascular invasion (P = 0.006), and lymph node involvement (P < 0.005) had negative impact on RFS. Conclusions Although elderly patients with cutaneous melanoma had different clinicopathologic features in our series, their survival rates are similar to those of younger patients, which shows that age alone is inadequate to determine the prognosis. Disease stage and a comprehensive geriatric assessment might assist to determine appropriate management.
Collapse
|