Dermoscopic and clinical features of head and neck melanoma

Abstract

BACKGROUNDThe dermoscopic criteria of extrafacial melanomas are well-known.OBJECTIVETo determine the frequency of dermatoscopic findings in head and neck melanomas (HNM) and to assess the distinguishing dermoscopic criteria of facial and extrafacial melanoma.METHODSThis observational study included 108 patients with HNM (63% male, mean age 64 years). Participants underwent individual dermoscopic imaging of clinically melanoma. All lesions were excised, and histopathological examination was performed on all specimens.RESULTSDrawing on histopathological analysis, lentigo maligna melanoma or lentigo maligna was diagnosed in 60 lesions, superficial spreading melanoma in 18, nodular in 10, desmoplastic in 8, superficial spreading melanoma in situ in 12. The most frequent location for head and neck melanoma was the cheek (60 patients, 55.6%). Eight prominent dermatoscopic features were observed in facial melanoma: annular-granular pattern (18%); rhomboidal structures (29%); pseudonetwork (29%); asymmetrical, pigmented, follicular openings (51%); obliterated hair follicles (8%); red rhomboidal structures (18%); increased density of the vascular network (32%); scar-like depigmentation (59%).CONCLUSIONSHNM has specific dermoscopic features, and classical extrafacial dermoscopic rules are less useful for diagnosis of facial melanoma. In our study, further characteristic dermatoscopic findings were detected in facial melanoma such as low frequencies of irregular dots, 2 or fewer colors in lesions, the presence of pseudonetwork, increased density of the vascular network, red rhomboidal structures, in addition to dermatoscopic findings of extrafacial melanoma. Thus, it is concluded that the prediction and identification of HNM may be evident with the help of these signs.

Dermoscopy vs. reflectance confocal microscopy for the diagnosis of lentigo maligna

“…Several dermoscopic and RCM diagnostic criteria of LM/LMM have been identified. However, there are no evaluations of the diagnostic accuracy of these two non‐invasive skin imaging techniques for LM/LMM using a holistic approach to image evaluation by experts instead of single diagnostic criteria.…”

Seven Non-melanoma Features to Rule Out Facial Melanoma

“…F acial flat pigmented lesions are a diagnostic challenge clinically and dermatoscopically, because many benign lesions show some degree of malignant features, and early melanoma may exhibit only subtle malignant criteria. The dermatoscopic presentation of facial melanoma (FM) was first described by Schiffner et al (1) and Stolz et al (2), followed by several studies (3)(4)(5)(6)(7)(8)(9)(10) reporting additional morphological clues. However, the differentiation of FM from pigmented actinic keratosis (pAK) remains one of the greatest challenges (4,10).…”

Diagnosing malignant melanoma in ambulatory care: a systematic review of clinical prediction rules

“…Alongside the use of CPRs, training in dermoscopy would seem to be a strategy that will enhance diagnostic accuracy of melanoma in the future particularly in light of emerging evidence of differences in dermoscopic features of melanoma such as head and neck melanoma. 81 It has also been highlighted that significant efforts are needed to standardise and improve dermoscopic terminology to more broadly promote the use of dermoscopy in the primary care setting. 82 Of the 24 rules identified in this review, four were clinical (ie, naked eye) and 17 were dermoscopic.…”