Dermoscopy And Reflectance Confocal Microscopy To Estimate Breslow Index And Mitotic Rate In Primary Melanoma

Abstract

Introduction: Non-invasive imaging techniques offer the possibility to optimize the first approach to melanoma. RCM has a promising role in predicting the main prognostic events in the dermoepidermal and papillary dermis.
 
 Objectives: To identify pre-surgical criteria that can predict the main prognostic features of melanoma.
 
 Methods: A retrospective cohort-study evaluated dermoscopic, confocal and histopathological characteristics of consecutively diagnosed sporadic melanomas. RCM-melanoma patterns classified into 1) dendritic-cell, 2) round-cell, 3) dermal nest and 4) combined type. Acral, facial and mucosal locations were excluded.
 
 Results: 92 primary melanomas were included: 44 male and 48 female (mean age 60.4 years, SD 16.2) with a mean Breslow of 1.43mm (SD 1.6). The most frequent dermoscopic presentation was the multicomponent pattern, the predominant confocal pattern was dendritic-cell type (44.6%). The presence of pigmented network on dermoscopy was related to lower Breslow and mitotic rates (both p=0.002); in contrast to the presence of visible vessels, which was related to higher Breslow and mitotic indexes (both p=0.001). Confocal observation of dermal nests or atypical cells in the papillary dermis was related to a higher mitotic rate (p=0.006 and p=0.03, respectively). Similarly, diffuse inflammatory infiltrates visible in the superficial dermis was associated with higher Breslow (p=0.04) and mitotic index (p=0.04).
 
 Conclusions: Dermoscopic and RCM in vivo findings on primary melanoma correlate with histopathologic Breslow index, mitotic rate and tumor infiltrating lymphocytes. The architecture and cytology of primary melanoma can be estimated by combining dermoscopy and RCM prior to excision.

Optically Guided High-Frequency Ultrasound Shows Superior Efficacy for Preoperative Estimation of Breslow Thickness in Comparison with Multispectral Imaging: A Single-Center Prospective Validation Study

“…Moreover, superficial dermal inflammation visible through confocal imaging was associated with higher Breslow and mitotic index ( p = 0.04). These findings indicate the potential of combined dermoscopy and RCM assessments in estimating primary melanoma characteristics and predicting crucial histopathologic parameters [ 56 ]. Furthermore, Fedorov et al have used an OCT-HFUS-Raman spectroscopy combined tool to virtually biopsy melanomas, harnessing the advantages of these different modalities [ 57 ].…”

Multiple Primary Melanoma: A Five-Year Prospective Single-Center Follow-Up Study of Two MC1R R/R Genotype Carriers

“…The tie of skin imaging technologies with cutaneous cancer diagnosis is a reality. For over three decades they have influenced how dermatologists perceive benign or malignant pigmented and non-pigmented lesion in correlation to phototype, phenotype, and genotype of patients [9,12,16,23,37,[44][45][46][47][48][49][50].…”

“…We retrieved thirty melanoma-specific dermoscopic structures from literature [23,36,38,45,[78][79][80][81][82][83][84][85][86]. The attending dermatologist selected up to six present melanoma-specific dermoscopic clues for each case (58 SPMs).…”

“…A combination of clinical total body skin exam (TBSE), total body skin photography (TBSP), and sequential digital dermoscopy imaging (SDDI), may ameliorate early-stage melanoma diagnosis (in-situ and thinner Breslow depth) [13,15,[20][21][22]. The additional level for examination of a suspect melanocytic lesion is by reflectance confocal microscopy (RCM), an in vivo, noninvasive, diagnostic tool that increases sensitivity for malignancy, improving physician's confidence, and resulting in a lower number of excised lesions [12,16,[23][24][25][26][27][28][29].…”

Spaghetti Technique Versus Wide Local Excision for Lentigo Maligna Affecting the Head and Neck Regions: Surgical Outcome and Descriptive Analysis of 79 Cases From a Single Practice Cohort

“…A major disadvantage of the ST is that the central tumor is not excised until the time of closure, so an unsuspected invasive melanoma would not be identified until after closure is complete [ 18 ]. This risk could be reduced by correlating the dermoscopy findings with the Breslow index and by performing a punch biopsy of the most suspicious area of depth [ 19 ]. From 2019 onwards, reflectance confocal microscopy (RCM) was used to delineate excision margins before surgery in all cases of LM, whether the surgical approach was WLE or ST.…”