Key dermoscopic signs in the diagnosis and progression of extrafacial lentigo maligna: Evaluation of a series of 41 cases

Villegas, Reyes Gamo; Franco, Ana Pampín; Muruzábal, Uxúa Floristán; García‐Zamora, Elena; Moraleda, Fernando Pinedo; López‐Estebaranz, José Luis

doi:10.1111/ajd.13051

Cited by 13 publications

(14 citation statements)

References 18 publications

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“…Interestingly, Jaimes et al [12] described asymmetrically pigmented perifollicular/adnexal openings in a series of non-facial H-CSD melanomas that in our opinion correspond to HM. These small dark-brown or blue-grey, triangular, or rounded structures at the border of 51.2% non-facial H-CSD LM were noted also by Gamo-Villegas et al [13].…”

Section: Discussionsupporting

confidence: 69%

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Diagnostic Accuracy of Hyperpigmented Microcircles in Dermatoscopy of Non-Facial Non-Acral Melanomas: A Pilot Retrospective Study using a Public Image Database

Pietkiewicz,

Giedziun,

Idziak

et al. 2023

Dermatology

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Background: Grey perifollicular circles are a dermatoscopic clue to melanoma, especially in facial skin. So far, no other adnexal clues than follicular have been investigated in this diagnosis. Objectives: The study aimed to analyse the prevalence of hyperpigmented periadnexal microcircles (HMs) in melanoma and its common simulators at non-facial non-acral sites, analyse the relation between the presence of HM, regression and hypopigmentation, and evaluate the diagnostic accuracy of this structure in melanoma. Methods: International Skin Imaging Collaboration (69,445 images) was searched in April 2020 for the pathology-confirmed dermatoscopic images with metadata including sex, age bin, and declared non-acral non-facial anatomic site. The final study sample (5,408 images, 1,326 of which were melanomas) was evaluated by expert dermatoscopist blinded to the diagnosis and labelled for the presence of ≥3 HM distributed centrally (cHM) or peripherally (pHM), hypopigmentation, and classic dermatoscopic regression structures. A subset of 40 images was labelled by 7 raters (2 residents, 5 experts) to assess interobserver agreement. We compared the presence of pHM with the presence of regression as well as performed a set of independent χ2 tests to evaluate the discriminatory power and its fragility. Performance of the models was assessed using measures of discrimination and calibration. Results: HM were significantly more prevalent in melanomas than in non-melanomas and nevi. Fair/good interobserver agreement for HM was reached for all the raters, and moderate/good for experts only (single rater/average, respectively). Regardless of regression/hypopigmentation status, pHM were significantly more common in melanoma than in non-melanomas or nevi and were observed significantly more often in melanomas on sun-damaged skin (upper extremity, posterior torso). No significant differences between the groups were found for cHM. pHM proved a high odds ratio in the tests as to the classical indicators such as classic dermatoscopic regression structures. Conclusion: pHM could be considered a novel dermatoscopic clue to melanoma.

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Section: Discussionsupporting

confidence: 69%

“…or blue-grey, triangular, or rounded structures at the border of 51.2% non-facial H-CSD LM were noted also by Gamo-Villegas et al [13].…”

Section: Discussionsupporting

confidence: 67%

Diagnostic Accuracy of Hyperpigmented Microcircles in Dermatoscopy of Non-Facial Non-Acral Melanomas: A Pilot Retrospective Study using a Public Image Database

Pietkiewicz,

Giedziun,

Idziak

et al. 2023

Dermatology

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“…Table 1 presents the complete dermoscopic checklist and metaphoric synonyms when applicable. Angulated lines were divided in “small” angulated lines, corresponding to the classic description of rhomboidal structures of facial LM [12]; and “large” angulated lines, described for extrafacial LM [20].…”

Section: Methodsmentioning

confidence: 99%

“…The main original studies addressing dermoscopy of LM included exclusively or predominantly facial lesions [12][13][14][15][16][17][18][19], or trunk and limbs extrafacial ones [15,20,21], but no subgroups of scalp LM have been analysed by these authors. Although the scalp is considered to be a special site on dermoscopy [4], the literature addressing the features of scalp melanomas and more specifically scalp LM is scarce [3,22].…”

Section: Introductionmentioning

confidence: 99%

Dermoscopy of Lentiginous Melanomas and Equivocal Benign Pigmented Macules of the Scalp: A Case-Control Multicentric Study

Regio Pereira,

Hirata,

Pietkiewicz

et al. 2023

Dermatology

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Introduction: Although the dermoscopic features of facial lentiginous melanomas (LM), including lentigo maligna and lentigo maligna melanoma, have been extensively studied, the literature about those located on the scalp is scarce. This study aims to describe the dermoscopic features of scalp LM and assess the diagnostic accuracy of dermoscopy to discriminate them from equivocal benign pigmented macules. Methods: Consecutive cases of scalp LM and histopathology-proven benign but clinically equivocal pigmented macules (actinic keratoses, solar lentigos, seborrhoeic keratoses, and lichen planus-like keratoses) from four referral centres were included. Dermoscopic features were analysed by two blinded experts. The diagnostic performance of a predictive model was assessed. Results: 56 LM and 44 controls were included. Multiple features previously described for facial and extrafacial LM were frequently identified in both groups. Expert’s sensitivity to diagnose scalp LM was 76.8% (63.6–87.0) and 78.6% (65.6–88.4), with specificity of 54.5% (38.9–69.6) and 56.8% (41.0–71.7), and fair agreement (kappa coefficient 0.248). The strongest independent predictors of malignancy were (OR, 95% CI) chaos of colour (15.43, 1.48–160.3), pigmented reticular lines (14.96, 1.68–132.9), increased density of vascular network (3.45, 1.09–10.92), and perifollicular grey circles (2.89, 0.96–8.67). The predictive model achieved 85.7% (73.8–93.6) sensitivity, 61.4% (45.5–75.6) specificity, and 81.5 (73.0–90.0) area under curve to discriminate benign and malignant lesions. A diagnostic flowchart was proposed, which should improve the diagnostic performance of dermoscopy. Conclusion: Both facial and extrafacial dermoscopic patterns can be identified in scalp LM, with considerable overlap with benign pigmented macules, leading to low specificity and interobserver agreement on dermoscopy.

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“…Polygons were angular lines in polygonal shapes [8], see Figure 6B. Structureless areas displayed no distinct features within the area concerned and had to occupy at least 20% of the melanoma "footprint", see Figure 5A.…”

Section: Introduction: Early Diagnosis Can Improve Melanoma Prognosis...mentioning

confidence: 99%

The hunt for baby melanomas: a prospective study of the dermoscopy features on 100 small melanoma cases with in vivo surface diameters up to a maximum of 6mm.

Pyne

MacDonald

Beale

et al. 2022

Dermatol Pract Concept

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Background:: Early diagnosis can improve melanoma prognosis. Dermoscopy can enhance early melanoma recognition. Objectives: Examine the dermoscopy features of early melanoma up to a maximum surface diameter of 6mm. Methods: Consecutive melanoma cases were collected from two medical practices in Sydney, Australia 2019-2021. Dermoscopy features were recorded for melanomas by maximum surface diameter, to the nearest 0.1 mm, to a limit of 6mm. Results: Total cases numbered 100; with males (n=48) and females (n=52), melanoma in situ (MIS, n=96) and invasive (n=4). The most frequent anatomic sites on both males and females were back (males n=20, females n=16) then knee or leg (males n=8, females n=12). Minimum respective MIS diameters for males/females was 1.2/2.0mm and for invasive cases 2.0/3.4mm. Highest frequency dermoscopy features were: light brown, dark brown, grey and asymmetric melanoma shape. Brown pigment in hair follicles were more frequent on legs compared to other anatomic sites [OR 14.6, 95%CI (1.29-165.17), p 0.03]. Pseudopods were substantially increased in frequency comparing diameters less than 4mm with 4 up to 6mm [OR 8.81, 95%CI (1.05-73.9), p 0.004]. Structureless area cases recorded increased grey [OR 7.08, 95%CI (1.61-31.11) p=0.01]. Melanomas with edge angulation were noted in 20-50% of cases across diameters 1-6mm, less frequent were pigmented circles and polygons. Conclusion: Watch out! MIS presented with a surface diameter of just 1.2 mm and invasive melanoma 2.5mm. Pseudopods were a strong clue to melanomas with a surface diameter less than 5mm. We found melanomas on leg sites displayed more frequent pigmented hair follicles.

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Key dermoscopic signs in the diagnosis and progression of extrafacial lentigo maligna: Evaluation of a series of 41 cases

Cited by 13 publications

References 18 publications

Diagnostic Accuracy of Hyperpigmented Microcircles in Dermatoscopy of Non-Facial Non-Acral Melanomas: A Pilot Retrospective Study using a Public Image Database

Diagnostic Accuracy of Hyperpigmented Microcircles in Dermatoscopy of Non-Facial Non-Acral Melanomas: A Pilot Retrospective Study using a Public Image Database

Dermoscopy of Lentiginous Melanomas and Equivocal Benign Pigmented Macules of the Scalp: A Case-Control Multicentric Study

The hunt for baby melanomas: a prospective study of the dermoscopy features on 100 small melanoma cases with in vivo surface diameters up to a maximum of 6mm.

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