Clinical and dermoscopic characteristics of melanomas on nonfacial chronically sun-damaged skin

BACKGROUND

Melanomas on chronically sun-damaged skin (CSDS) can be difficult to identify and often manifest morphologic features that overlap with benign lesions.

OBJECTIVE

We describe and analyze the clinical and dermoscopic characteristics of melanomas on nonfacial CSDS.

METHODS

Melanoma cases on nonfacial CSDS were retrospectively identified from the biopsy specimen logs of 6 melanoma clinics. Clinical and dermoscopic images were combined into 1 database. Demographics, clinical, dermoscopic, and histopathologic information were analyzed. Descriptive frequencies were calculated.

RESULTS

One hundred eighty-six cases met the inclusion criteria: 142 melanomas in situ (76%) and 39 invasive (21%; mean thickness, 0.49 mm). Lentigo maligna was the most common histopathologic subtype (n = 76; 40.9%). The most frequent dermoscopic structures were granularity (n = 126; 67.7%) and angulated lines (n = 82; 44%). Vascular structures were more frequent in invasive melanomas (56% vs 12% of in situ melanomas). Most manifested 1 of 3 dermoscopic patterns: patchy peripheral pigmented islands, angulated lines, and tan structureless with granularity pattern.

LIMITATIONS

This was a retrospective study, and evaluators were not blinded to the diagnosis. In addition, interobserver concordance and sensitivity and specificity for dermoscopic structures were not evaluated.

CONCLUSION

Outlier lesions manifesting dermoscopic structures, such as granularity, angulated lines, or vessels and any of the 3 described dermoscopic patterns should raise suspicion for melanoma.

Use of and beliefs about total body photography and dermatoscopy among US dermatology training programs: an update

BACKGROUND

Total body photography (TBP) and dermatoscopy are imaging techniques used to treat patients with pigmented lesions.

OBJECTIVE

We sought to describe use, training, logistics, and beliefs about these tools among residency programs and to assess changes during a 10-year period.

METHODS

Surveys were sent to all directors (n = 111) and chief residents (n = 109) of US dermatology training programs.

RESULTS

A total of 83 (74.8%) attendings answered the questionnaire. In all, 59 (71.1%) reported using TBP, an 11.9% increase (P = .2484) over the past decade. Reasons for using TBP included: reduces patient anxiety (81.4%), helps detect early melanoma (78.0%), and leads to fewer biopsies (66.1%). Logistical (79.2%) and financial (45.8%) constraints were reasons for not using TBP. Seventy respondents (84.3%) reported using dermatoscopy, a 40.0% increase (P = .0001) over the 10-year period. Reasons for dermatoscopy use were consistent over time: helps find melanoma in curable stage (75.7%), reduces patient anxiety (61.4%), and leads to fewer biopsies (57.1%). The most common reason for not using dermatoscopy remained lack of training (38.5%). A total of 92 (84.4%) residents completed their survey, of which 41 (44.6%) and 81 (88.0%) reported using TBP and dermatoscopy, respectively. In all, 62 (67.4%) and 79 (85.9%) respondents would prefer additional training in TBP and dermatoscopy, respectively.

LIMITATIONS

Results may not be applicable to the general dermatology community.

CONCLUSIONS

Use of dermatoscopy among residency programs has increased significantly during the last decade. A more modest increase in the use of TBP was observed. Barriers to diffusion of these technologies into practice persist, including insufficient logistics and training.