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PubMed2002

Management of dysplastic nevi: a survey of fellows of the American Academy of Dermatology.

BACKGROUND: Opinions concerning the significance of dysplastic nevi and their management vary among dermatologists. OBJECTIVE: The purpose of this study was to assess how fellows of the American Academy of Dermatology (AAD) perceive and manage dysplastic nevi. METHODS: Questionnaires were sent to 1216 fellows of the AAD; 456 questionnaires were returned. RESULTS: Almost all respondents (98%) accept the dysplastic nevus, or atypical mole, as an entity. Seventy-five percent of respondents perform follow-up total cutaneous examinations on all their patients with dysplastic nevi, and another 22% on some of them; 86% usually intend to do total removals when they perform biopsies of dysplastic nevi; 75% use margins of 2 mm or less when removing dysplastic nevi; 49% order baseline total-cutaneous photographs of some or all of their patients with multiple dysplastic nevi, although only 12% do so routinely; 67% prefer to re-excise dysplastic nevi when margins are positive, some using histologic atypia as a criterion; 60% recommend an ophthalmologic examination for at least some of their patients with many dysplastic nevi, although only 3% do so routinely; 12% always recommend cutaneous examinations of blood relatives of their patients with dysplastic nevi and another 81% recommend such examinations for at least some of their patients with dysplastic nevi; 23% use dermoscopy; 99% recommend self-examination; almost 100% recommend sunscreen use and 93%, sun avoidance. CONCLUSION: Most respondents, in agreement with the literature, accept the concept that patients with dysplastic nevi are at increased risk for melanoma and that methods for prevention and early detection of melanomas are appropriate for these patients.

Attitude of Health Personnel↗

PubMed2003

Early melanoma detection: nonuniform dermoscopic features and growth.

BACKGROUND: Dermoscopy alone is not sufficient to detect all early melanomas. Total body photos reveal growth of melanomas but also reveal growth of melanocytic nevi. OBJECTIVE: We set out to determine whether a simplified algorithm on the basis of nonuniform dermoscopic features combined with growth noted from baseline total body photos targeted the early melanocytic neoplasms most likely to be malignant. METHODS: Lesions removed during follow-up of patients with total body photographs were reviewed and 169 melanocytic lesions were identified for which both gross clinical and dermoscopic photos were available. The images were evaluated separately by 3 academic dermatologists, without knowledge of the given pathologic diagnosis, for uniformity (consistent gradient of features from center to edge) and change (specifically, that which could indicate melanoma growth in normal skin or within a nevus). RESULTS: Using a minimum of 2 out of 3 agreement for uniformity and change, 12 of 16 melanomas (including all 5 superficially invasive tumors) were graded as nonuniform and changed. The 4 melanomas not included in this category were in situ. The predicted odds of melanoma for lesions scored as both nonuniform and changed was 4.06 (P >.0195). If 3 out of 3 agreement was used, the odds ratio increased to 6 (P >.0010). CONCLUSION: An algorithm on the basis of dermoscopic nonuniformity and change suggestive of growth as determined by total body photography segregates melanocytic neoplasms most likely to be malignant.

Algorithms↗

PubMed2004

The use and application of special techniques in assessing melanocytic tumours.

To improve diagnostic accuracy, a number of novel techniques have been developed to assist in the evaluation of melanocytic tumours. Dematologists have begun to explore the use of new instruments, such as dermoscopy or confocal scanning laser microscopy, in their clinical assessment of pigmented lesions. They have also benefited from advances in digital photography and applied this technique to monitor patients with numerous atypical naevi. Likewise, the diagnostic armamentarium of pathologists has been enriched over the past decade. A number of new reagents have become available for immunohistochemical analysis of melanocytes in archival material, such as antibodies to tyrosinase, Melan-A/Mart-1, micropthalmia-associated transcription factor and PNL2. These markers have allowed improvements in the sensitivity and specificity in the diagnosis of melanoma and its distinction from histological mimics. However, some pitfalls in the use of various reagents have also become apparent. Most recently, molecular techniques are being explored for their potential use in the diagnosis of melanoma. In this review, various modalities are discussed with regard to their application in the evaluation of melanocytic neoplasms.

Biomarkers, Tumor↗

PubMed2026

Spitz tumours: Current insights and challenges in diagnosis and management.

Spitz tumours are a distinct subtype of melanocytic lesions composed of epithelioid and/or spindled cells. They comprise Spitz naevi (SN), atypical Spitz tumours/Spitz melanocytoma (AST), and Spitz melanoma (SM). According to the 5th WHO Classification, SM is defined by the co-occurrence of spitzoid morphology and a Spitz-defining genomic alteration, typically a kinase fusion or HRAS mutation, making it a molecularly distinct entity. Molecularly confirmed SM is exceedingly rare, usually occurs in younger adults, and appears to demonstrate a more favorable clinical course than spitzoid melanoma driven by BRAF or NRAS mutations, although robust comparative data remain limited. Dermoscopy may raise clinical suspicion based on characteristic patterns and remains an important first-line diagnostic tool; however, it cannot reliably distinguish AST from SM. In addition, Spitz tumours may exhibit overlapping histopathological features, further complicating their differentiation. In particular, the distinction between ASTs and SMs is often challenging. Immunohistochemical and molecular analyses, particularly next-generation sequencing (NGS), play a crucial role in resolving diagnostically challenging Spitz tumours and in differentiating true Spitz tumours from their morphological mimics. Furthermore, NGS contributes to improved risk stratification and has revealed high-risk genomic alterations associated with progression. Increased application of molecular techniques is expected to refine prognostic assessment and support individualized management strategies.

Journal Article↗

PubMed1996

A sensitivity and specificity analysis of the surface microscopy features of invasive melanoma.

In vivo cutaneous surface microscopy, epiluminescence microscopy, dermoscopy, dermatoscopy and magnified oil immersion diascopy, are terms that describe the use of an incident light magnification system to examine cutaneous lesions, usually with immersion oil at the skin-microscope interface. The result is the visualization of a multitude of morphological features, not visible with the naked eye, that enhance the clinical diagnosis of nearly all pigmented lesions. Sixty-two invasive melanomas and 159 randomly selected non-melanoma pigmented lesions were used in the study. The non-melanomas, while randomly selected from a large data base, were all clinically atypical. Using the x 10 magnification of hand-held surface microscopes (Dermatoscope, Episcope), we present an analysis of 72 surface microscopic variables (constituting over 15,000 single observations) for the diagnosis of invasive melanoma. Forty of the 72 features studied were shown to differ significantly between invasive melanoma and non-melanoma pigmented lesions. Blue-white veil, multiple brown dots, radial streaming and pseudopods had a specificity greater than 95% for melanoma. Two features, symmetrically irregular pigment (non-uniform pigmentation with point and axial symmetry) and the presence of a single colour, had a sensitivity of 0%, i.e. were absent, in melanoma. The other significant features are presented, with their sensitivity and specificity for melanoma.

Humans↗

PubMed1998

Sensitivity in the clinical diagnosis of malignant melanoma.

Accurate clinical diagnosis of malignant melanoma is of great importance for early detection and further treatment. The purpose of this retrospective study was to evaluate the accuracy of clinical diagnosis by using different clinical and histopathological parameters. Calculations are based on a total of 44,258 histopathologically examined skin neoplasms, including 529 melanomas, which were recorded in the histological database of the Department of Dermatology, University of Graz during a 2 year period. The clinical diagnosis of the referring physicians was compared statistically with the final histopathological interpretation. Clinical diagnosis of melanoma showed a sensitivity of 70.1%, a specificity of 99.4%, and a positive predictive value of 60.7%. One hundred and fifty eight melanomas (29.9%) could not be diagnosed clinically. The age-dependent sensitivity was 47.6% in patients <40 years, whereas for patients >80 years the value was 90.2%. Remarkably, the sensitivity in melanomas >4 mm thickness (64.8%) was lower than in 'melanoma in situ' (72.6%). Our findings underline the importance of further development of clinical examination techniques such as dermoscopy and digital epiluminescence microscopy.

Adult↗

PubMed2006

Malignant melanoma metastatic to a basal cell carcinoma simulating the pattern of a basomelanocytic tumor.

We report a case of metastatic melanoma colliding with and colonizing a basal cell carcinoma (BCC) on the head of a 69-year-old man. The man had a prior history of multiple primary BCCs and melanomas. One of his primary melanomas, on the left scalp, recurred locally and resulted in the development of numerous in-transit metastases. A bluish nodule was noted on the postauricular area with clinical features consistent with a pigmented BCC. Dermoscopy showed some large gray-blue ovoid structures and blood vessels, features also consistent with BCC. However, the histologic features revealed that the nodule consisted of both metastatic melanoma as well as BCC. Melanoma was present adjacent to as well as within the epithelium of the BCC. The intimate association of melanoma cells within the nodules of BCC simulated the pattern of so-called "malignant basomelanocytic tumor," a recently proposed novel entity. To our knowledge, this is the first description of metastatic melanoma colonizing a BCC.

Aged↗

PubMed2004

Eruptive multiple blue nevi of the penis: a clinical dermoscopic pathologic case study.

Multiple blue nevi have rarely been reported, and the majority of the lesions are located on the trunk and lower extremities. The blue nevus is a rare lesion on genital mucosa and may cause confusion in differential diagnosis with other pigmented lesions such as genital melanocytic macules, lentigo simplex, and malignant melanoma. Here, we describe an unusual patient who presented with a sudden onset in adulthood of multiple blue nevi on the glans penis. The epiluminescence examination revealed a substantially homogenous bluish pigmentation, which led us to favor a diagnosis of blue nevus, whereas not entirely excluding the possibility of a regressing melanoma or a metastatic melanoma. Because of the well-known diagnostic value of the blue hue in the diagnosis of malignancy by dermoscopy, a careful examination of these lesions should be made in order to minimize any risk of misclassification with melanoma.

Adult↗

PubMed2004

Clinically equivocal melanocytic skin lesions with features of regression: a dermoscopic-pathological study.

BACKGROUND: Benign melanocytic skin lesions may be difficult to differentiate from melanoma both clinically and dermoscopically. One of the most confounding dermoscopic features, commonly seen in melanoma but in our experience also in melanocytic naevi, is represented by the so-called blue-white structures (BWS). OBJECTIVES: To evaluate diagnostic significance and histopathological correlates of BWS seen by dermoscopy in a series of clinically equivocal melanocytic skin lesions that were excised. METHODS: Patients were recruited from six specialized pigmented lesion clinics in Austria, Italy and Spain over a period of 9 months. All consecutive patients showing one or more melanocytic lesions with BWS, but not classified as melanoma dermoscopically, were included. Each lesion was photographed clinically and dermoscopically. All images were reviewed by one of us and the degree, type and location of BWS evaluated for each lesion. A panel of four experienced dermatopathologists independently reviewed all specimens for diagnosis and one of them evaluated presence and degree of melanosis and/or fibrosis. The main outcome measures were the percentage and histopathological correlates of lesions with different degree, type and location of BWS. RESULTS: All included lesions with BWS (n = 158) showed partial or focal regression histopathologically. One hundred and thirty-five (85.4%) lesions were diagnosed as melanocytic naevi (complete histopathological interobserver agreement), whereas 23 (14.6%) were defined as equivocal because at least one of four pathologists diagnosed the given lesion as melanoma. Only one lesion was diagnosed as melanoma by all four pathologists. The majority of naevi exhibited blue areas (84.4%) with a central distribution (57%) and involving < 50% of the lesion surface (89.6%). By contrast, 78.3% of equivocal lesions revealed a combination of white and blue areas with an irregular distribution (60.9%) and involving > 50% of the lesion surface (47.8%). CONCLUSIONS: Using degree and type of BWS, an algorithm was constructed that can be applied for the management of lesions exhibiting dermoscopic features of regression.

Adolescent↗

PubMed1993

Spotted cicatricial alopecia in dark skin. A dermoscopic clue to fibrous tracts.

Study of areas of cicatricial alopecia in a 42 year old black woman by dermoscopy with oil revealed uniform pale dots associated with a radiating pigment network. Scalp biopsy showed a cicatricial alopecia with lichen planopilaris and multiple fibrous tracts. The pale dots appear to correspond to focal decrease in epidermal melanin pigment overlying the site of the fibrous tracts and may provide a dermoscopic clue in analysing the cicatricial alopecias.

Adult↗

PubMed1997

Surface microscopy of pigmented skin tumours.

In vivo cutaneous surface microscopy, epiluminescence microscopy, dermatoscopy and dermoscopy are terms that all describe the same process of examination of cutaneous lesions with an incident light magnification system with oil at the skin-microscope interface. Increased investigation in surface microscopy has occurred in the last decade, primarily because of the introduction of inexpensive hand-held instruments. Research has focused particularly on morphological definitions, diagnostic models and image analysis systems. In this paper, these issues are discussed, and the relevant controversies highlighted.

Diagnosis, Computer-Assisted↗

PubMed2006

Homogeneous blue pigmentation in dermatofibroma simulating a blue naevus.

A case with a pigmented skin lesion that was diagnosed as a blue naevus on clinical and dermoscopic grounds and histopathologically confirmed as a dermatofibroma is presented. By means of this case, we define dermatofibroma as a new exception for 'homogeneous blue pigmentation' on dermoscopy.

Aged↗

PubMed2005

Striae distensae in darker skin types: the influence of melanocyte mechanobiology.

INTRODUCTION: Striae distensae in White people are commonly described as being reddish at first and turning white in time. This dual perception has been challenged. Indeed, the color difference between striae distensae and their surrounding skin varies on a wide range in part depending upon typology. AIM: To study striae nigrae that are found only in subjects of darker complexion. MATERIALS AND METHODS: In the present study conducted in 44 darker skin adults, dermoscopy was combined to reflectance colorimetry. RESULTS: Striae nigrae exhibited hypermelanosis of the epidermal rete ridges crossing transversally the lesions in a laddering pattern. By contrast, striae albae showed only faint melanotic networks. CONCLUSIONS: As striae distensae are in part under the influence of skin stretching, their colors are likely to be controlled by some mechanobiological process activating or inhibiting melanogenesis in people of darker complexion. No argument involving an inflammatory mechanism is supported by the present observations.

Journal Article↗

PubMed2004

Noninvasive imaging of skin tumors.

In this article, the authors review different approaches to the diagnosis of skin tumors using noninvasive diagnostic tools, which are becoming increasingly reliable and, as a consequence, increasingly popular among physicians and patients. Especially in the realm of pigmented skin lesions, dermoscopy and sonography may add useful information to the clinical constellation, improving the diagnostic performance for early diagnosis of melanoma and for differentiating various melanocytic and nonmelanocytic pigmented lesions. More recently, confocal scanning laser microscopy was introduced as a novel technique that enables the in vivo study of the skin at a nearly histologic resolution, being of diagnostic value in various skin disorders, including basal cell carcinoma and pigmented skin lesions. These modalities have various other potential applications besides diagnosis, including lesion's selection for biopsy, determination of appropriate therapeutic modalities, verification of treatment efficacy, and decision of surgical margins. Finally, a hint to the use of cytodiagnosis for basal cell carcinoma is provided.

Basal Cell Carcinoma↗

PubMedDate not supplied

Cutaneous melanoma: public health approach to early detection.

Melanoma is a major public health problem. There will be a projected 60,000 cases of invasive melanoma diagnosed in 2005, and that number is increasing each year. Fortunately, the prognosis is improving as well, but we still have approximately 8000 deaths per year related to this tumor. To reduce this number of deaths, we need to look at the skin--inspect--and see--recognize potential early melanomas when we look at them. Most of the population does not see a dermatologist regularly, and there are many barriers to general clinicians inspecting the skin, including inadequacy of dermatologic skills. Patients are ultimately responsible for their own skin, but only a small proportion of people actually perform thorough skin self-examination on a recommended monthly basis. There are various tools used by some dermatologists to facilitate early detection, including total body and lesional photography and epiluminescence microscopy (dermoscopy) of lesions. A basic skin cancer triage algorithm has been developed and tested in primary care, with promising results for improving practice. The general population also needs better guidance on early melanoma detection. Hence, instead of relying on the "ABCDs" for a morphologic diagnosis, the message of "a new or changing skin lesion" is being promoted to facilitate early diagnosis of thin, curable tumors. Together, patients and clinicians can improve early detection to reduce melanoma-related mortality.

Early Diagnosis↗

PubMedDate not supplied

Diagnosis and treatment of cutaneous melanoma: a practical guide.

During the past decades, a number of new scientific evidences have been provided allowing a better understanding of the nature of cutaneous melanoma. New scientific methods, such as dermoscopy, have been shown to improve the diagnostic accuracy of pigmented skin lesions and early recognition of melanoma. Aggressive approaches for the surgical treatment of melanoma have been shown to be useless and have been replaced by more conservative surgical protocols and by sentinel lymph node biopsy. In the advanced stage of melanoma, new chemotherapy protocols and immunotherapy have been proposed, whereas the role of vaccines is still under investigation. In this review, the authors present an up-to-date overview of the epidemiologic, clinical, histopathologic, and therapeutic aspects of melanoma that can be used as a practical guide for the management of this tumor.

Combined Modality Therapy↗

PubMed2004

Inter- and intra-variability of pigmented skin lesions: could the ABCD rule be influenced by host characteristics?

BACKGROUND/PURPOSE: Many differences in color, shape and dimension exist between different moles even in the same individual. Major differences might be accounted for anatomical location, genetic factors and by environmental factors, mainly sunlight exposure. Therefore, it would be of great value, when evaluating skin lesions, to take into account the degree of intra- and inter-variability of several diagnostic parameters. In order to assess the morphologic and chromatic differences between lesions belonging to different patients and between lesions belonging to the same individual, we examined objective digital parameters obtained with dermatoscopic analysis, using the DBDermo MIPS system (BIO MIPS Engineering, S.R.L, siena, Italy). METHODS: The automatic classifier inside the software is based on a 'match by similarity' algorithm, based on the measurement of the Euclidean distances of all variables considered from the reference image. Two-hundred and four clinically benign pigmented lesion, belonging to 18 patients were examined, stored and automatically processed. For each lesion objective parameters related to geometry, color and texture were automatically evaluated. RESULTS: We found skin color (healthy skin) is objectively different from subject to subject and the lesion color is more similar among different lesions of the same patient than among lesions belonging to different individuals both in their darkest and slightly dark component. We also observed that lesion dimensions are individual correlates, i.e. the probability for a lesion to be large is higher when the other, in the same patient, is large. CONCLUSION: Many parameters of pigmented skin lesions evaluated by digital dermoscopy analysis are similar in the same patient and different from those belonging to different individuals. This indicates that, when considering a lesion, we should take into account the peculiar patient's characteristics.

Diagnosis, Computer-Assisted↗

PubMed2001

The dermatoscopic pattern of clear-cell acanthoma resembles psoriasis vulgaris.

BACKGROUND: Dermatoscopy (dermoscopy, epiluminescence microscopy) is used for the early detection of malignant tumors and avoidance of unnecessary excisions of benign skin tumors. OBJECTIVE: Description of the dermatoscopic pattern of clear-cell acanthoma. METHODS: Video dermatoscopy at 20-fold magnification of a clear-cell acanthoma and psoriasis vulgaris. RESULTS: Homogeneous, symmetrically or bunch-like arranged, pinpoint-like capillaries were seen in the clear-cell acanthoma and in psoriasis vulgaris. CONCLUSION: The dermatoscopic psoriasis-like pattern of clear-cell acanthoma is a diagnostic clue which may help the clinician to identify this benign epidermal tumor and to differentiate it from other benign and malignant tumors of the skin.

Capillaries↗