Dermoscopy for early detection of facial lentigo maligna

Department of Dermatology, University of Florence, Via Alfani 37, 50121 Florence, Italy.
British Journal of Dermatology (Impact Factor: 4.28). 03/2005; 152(2):361-4. DOI: 10.1111/j.1365-2133.2004.06328.x
Source: PubMed


Up until now, only lesions selected on the basis of their clinical atypia or which appear equivocal on naked eye examination have been shown to benefit from the use of dermoscopy. In our experience, dermoscopic evaluation of lesions located on the face may require a different approach, as a histopathological diagnosis of malignancy is not uncommon in clinically trivial lesions (i.e. lesions lacking the ABCD criteria for clinical suspicion). Moreover, at this site dermoscopy reveals specific criteria according to the particular histological architecture shown by sun-damaged skin. We report four cases of lentigo maligna (LM) of the face whose identification depended on dermoscopic examination which was performed routinely on all facial lesions, as the lesions did not show ABCD clinical criteria for malignancy. In our experience, the identification of early signs of malignancy by dermoscopy may indicate the excision of LM at an early phase, before the lesion is associated with the ABCD signs of melanoma. Dermatologists should avoid the mistake of immediately excluding a diagnosis of malignancy when examining an ABCD-negative pigmented skin lesion of the face.

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    • "In our experience, dermoscopic evaluation of pigmented lesions located on the face may require a different approach, as many of them are nonmelanocytic in nature. Moreover, at this site, dermoscopy reveals specific criteria according to the particular histological architecture shown by sun-damaged skin [1]. For example, under dermoscopy , the presence of a pseudonetwork is characteristic of pigmented nonmelanocyte lesions on the face. "
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    ABSTRACT: Four types of facial pigmented skin lesions (FPSLs) constitute diagnostic challenge to dermatologists; early seborrheic keratosis (SK), pigmented actinic keratosis (AK), lentigo maligna (LM), and solar lentigo (SL). A retrospective analysis of dermoscopic images of histopathologically diagnosed clinically-challenging 64 flat FPSLs was conducted to establish the dermoscopic findings corresponding to each of SK, pigmented AK, LM, and SL. Four main dermoscopic features were evaluated: sharp demarcation, pigment pattern, follicular/epidermal pattern, and vascular pattern. In SK, the most specific dermoscopic features are follicular/epidermal pattern (cerebriform pattern; 100% of lesions, milia-like cysts; 50%, and comedo-like openings; 37.50%), and sharp demarcation (54.17%). AK and LM showed a composite characteristic pattern named "strawberry pattern" in 41.18% and 25% of lesions respectively, characterized by a background erythema and red pseudo-network, associated with prominent follicular openings surrounded by a white halo. However, in LM "strawberry pattern" is widely covered by psewdonetwork (87.5%), homogenous structureless pigmentation (75%) and other vascular patterns. In SL, structureless homogenous pigmentation was recognized in all lesions (100%). From the above mentioned data, we developed an algorithm to guide in dermoscopic features of FPSLs.
    02/2013; 2013:546813. DOI:10.1155/2013/546813
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    • "Clinically, LM is often amelanotic peripherally, and can spread far beyond the visible margins (McKenna et al., 2006). Dermoscopy (Schiffner et al., 2000; Robinson, 2004; Stante et al., 2005) and Wood's light examination (Jeneby et al., 2001) have been described as useful techniques to better define the extent of the lesion. Mohs' surgery (Zitelli et al., 1991; Bricca et al., 2005; Bhardwaj et al., 2006; Bene et al., 2008), staged excision (Bub et al., 2004; Huilgol et al., 2004; Mahoney et al., 2005; Hazan et al., 2008), and threedimensional histology (Moehrle et al., 2006) have been proposed as techniques to more precisely delineate the margins of LM but are expensive and the procedures require a high degree of expertise (Barlow et al., 2002, 2007). "
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    ABSTRACT: Limited studies have reported the in vivo reflectance confocal microscopy (RCM) features of lentigo maligna (LM). A total of 64 RCM features were scored retrospectively and blinded to diagnosis in a consecutive series of RCM sampled, clinically equivocal, macules of the face (n=81 LM, n=203 benign macules (BMs)). In addition to describing RCM diagnostic features for LM (univariate), an algorithm was developed (LM score) to distinguish LM from BM. This comprised two major features each scoring +2 points (nonedged papillae and round large pagetoid cells > 20 microm), and four minor features; three scored +1 point each (three or more atypical cells at the dermoepidermal junction in five 0.5 x 0.5 mm(2) fields, follicular localization of atypical cells, and nucleated cells within the dermal papillae), and one (negative) feature scored -1 point (a broadened honeycomb pattern). A LM score of > or = 2 resulted in a sensitivity of 85% and specificity of 76% for the diagnosis of LM (odds ratio (OR) for LM 18.6; 95% confidence interval: 9.3-37.1). The algorithm was equally effective in the diagnosis of amelanotic lesions and showed good interobserver reproducibility (87%). In a test set of 29 LMs and 44 BMs, the OR for LM was 60.7 (confidence interval: 11.9-309) (93% sensitivity, 82% specificity).
    Journal of Investigative Dermatology 08/2010; 130(8):2080-91. DOI:10.1038/jid.2010.84 · 7.22 Impact Factor
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    ABSTRACT: Ein 75-jähriger Patient berichtete über das erneute Auftreten einer pigmentierten Makula der linken Wange. Diese Läsion war zuvor unter der Vorstellung einer pigmentierten seborrhoischen Keratose kryotherapiert und kürretiert worden. Die Dermatoskopie deutete aufgrund der asymmetrisch pigmentierten Follikelöffnungen, Streifen („streaks“), rhombenförmigen Strukturen sowie Arealen mit homogener teils graublauer Pigmentierung auf das Vorliegen einer Lentigo maligna hin. Die histologische Untersuchung bestätigte das Vorliegen eines bereits invasiven Lentigo-maligna-Melanoms (0,3 mm Tumordicke nach Breslow).
    Der Hautarzt 02/2012; 63(2). DOI:10.1007/s00105-011-2315-6 · 0.56 Impact Factor
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