New Trends in Dermoscopy to Minimize the Risk of Missing Melanoma

Abstract

During the last decades, induction of dermoscopy in the clinical setting resulted in significant modifications in the management of melanocytic lesions. Indeed, the dermatoscope reveals a fascinating world of morphologic structures invisible to the naked eye, adding valuable information to a clinician evaluating a mole. However, since the technique counts only a couple of decades, new research data are continuously gathering and modify the “optimal” management of melanocytic lesions. In the present paper, we summarize the latest trends in dermoscopy concerning early melanoma diagnosis, management of nodular lesions, diagnosis of mucosal melanoma, and digital followup.

Predstavitev Primera: Nodularni Melanom

“…Nodulani melanom lahko zato zamenjamo za benigne kožne tumorje, kot so vaskularni tumorji, dermalni in t. i. blue nevusi, dermatofibromi ter seboroične keratoze. 5 Nodularni melanom predstavlja le 10-15 % vseh melanomov, vendar kar 70 % tistih, ki so po Breslowu debelejši od 3 mm.6 Debelina po Breslowu je najpomembnejši napovedni dejavnik preživetja bolnikov z melanomom. 7 Najpomembnejši okoljski dejavnik tveganja za razvoj melanoma je intermitentna izpostavljenost ultravijoličnemu sevanju, vendar ta povezava ni značilna za nodularni podtip melanoma.8…”

“…Prav tako ga lahko zamenjamo z ostalimi malignimi kožnimi tumorji in celo z vnetnimi spremembami, še posebej, če ni pigmentiran. 5 Ker algoritem ABCDE pri nodularnemu melanomu odpove, so nekateri avtorji KLiNičNi PRiMER/CASE REPORT predlagali algoritem EFG (angl. elevation, firmnes, growth).…”

“…Zaradi kratke klinične rabe algoritma EFG zaenkrat še ni pomembnejših podatkov o njegovem pomenu. 5 Retrospektivna študija Lina in sodelavcev je pokazala, da je pravilno diagnosticiranih samo 41 % nodularnih melanomov ter da so specialisti dermatologi, v primerjavi s specialisti družinske medicine, statistično pomembno boljši pri njihovem prepoznavanju.14 Nodularni melanom zaseva že zgodaj v poteku bolezni. Zasevki so velikokrat prisotni še preden bolezen klinično prepoznamo.9 Tudi predstavljeni bolnik je imel ob postavitvi diagnoze mikrozasevke v varovalnih bezgavkah.…”

Modern non-invasive diagnostic techniques in the detection of early cutaneous melanoma

“…A ten-year multicenter study showed that the use of dermoscopy decreases the number of unnecessary excised benign melanocytic lesions and increases the number of detected melanomas. 4,5 of single melanocytic lesions, while medium (every 6 months) and long-term (every 12 months) follow up is focused on monitoring of multiple lesions. The lesions selected for shortterm follow-up usually fall into two categories: moderately atypical lesions without a history of change and mildly atypical nevi with a history of change.…”

“…These are: the pattern analysis by Pehamberger, the ABCD rule by Stolz, the ABC rule modified by Kittler, the Menzies method, the seven-point checklist by Argenziano, the CASH algorithm and other. 4,6,15,16 Figures 1 and 2 show typical dermoscopy features of thin versus thick melanomas. The images were taken with a digital dermoscope (videodermoscope).…”