Reflectance Confocal Microscopic and En Face Histopathologic Correlation of the Dermoscopic “Circle Within a Circle” in Lentigo Maligna

Navarrete‐Dechent, Cristián; Liopyris, Konstantinos; Córdova, Miguel; Busam, Klaus J.; Marghoob, Ashfaq A.; Chen, Chih‐Shan Jason

doi:10.1001/jamadermatol.2018.2216

Cited by 11 publications

(8 citation statements)

References 8 publications

(13 reference statements)

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“…OCT criteria were those used in a recent study . In these cases, a histopathologic correlation was performed using the precision biopsy technique, as previously described . In brief, precision biopsy enables 1-to-1 correlation with en face histopathologic images were evaluated by a Mohs micrographic surgeon (C.-C.J.C.)…”

Section: Methodsmentioning

confidence: 99%

Association of Multiple Aggregated Yellow-White Globules With Nonpigmented Basal Cell Carcinoma

et al. 2020

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IMPORTANCEBasal cell carcinoma (BCC) is the most common skin cancer. Dermoscopic imaging has improved diagnostic accuracy; however, diagnosis of nonpigmented BCC remains limited to arborizing vessels, ulceration, and shiny white structures.OBJECTIVE To assess multiple aggregated yellow-white (MAY) globules as a diagnostic feature for BCC. DESIGN, SETTING, AND PARTICIPANTSIn this retrospective, single-center, case-control study, nonpigmented skin tumors, determined clinically, were identified from a database of lesions consecutively biopsied during a 7-year period (January 1, 2009, to December 31, 2015. A subset of tumors was prospectively diagnosed, and reflectance confocal microscopy, optical coherence tomography, and histopathologic correlation were performed. Data analysis was conducted from July 1 to September 31, 2019.EXPOSURES Investigators evaluated for the presence or absence of known dermoscopic criteria. MAY globules were defined as aggregated, white-yellow structures visualized in polarized and nonpolarized light. MAIN OUTCOMES AND MEASURESThe primary outcome was the diagnostic accuracy of MAY globules for the diagnosis of BCC. Secondary objectives included the association with BCC location and subtype. Interrater agreement was estimated.RESULTS A total of 656 nonpigmented lesions from 643 patients (mean [SD] age, 63.1 [14.9] years; 381 [58.1%] male) were included. In all, 194 lesions (29.6%) were located on the head and neck. A total of 291 (44.4%) were BCCs. MAY globules were seen in 61 of 291 BCC cases (21.0%) and in 3 of 365 other diagnoses (0.8%) (P < .001). The odds ratio for diagnosis of BCC was 32.0 (96% CI, 9.9-103.2). The presence of MAY globules was associated with a diagnosis of histologic high-risk BCC (odds ratio, 6.5; 95% CI, 3.1-14.3). The structure was never seen in cases of superficial BCCs. CONCLUSIONS AND RELEVANCEThe findings suggest that MAY globules may have utility as a new BCC dermoscopic criterion with a high specificity. MAY globules were negatively associated with superficial BCC and positively associated with deeper-seated, histologic, higher-grade tumor subtypes.

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Section: Methodsmentioning

confidence: 99%

Association of Multiple Aggregated Yellow-White Globules With Nonpigmented Basal Cell Carcinoma

et al. 2020

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“…Navarrete-Dechent et al. ( 16 ) also matched the dermoscopic sign “circle within a circle” of lentigo maligna (presence of pigmentation within and around hair follicles) with its RCM and HHS: RCM revealed the presence of hair follicles surrounded by numerous dendritic bright melanocytes and layers of keratinocytes filled at the periphery with rounded/elongated hyperreflective melanocytes. HHS strongly overlapped with RCM, showing a high pigmentation of the keratinocytes of the basal layer of the epidermis combined with an increased number of junctional melanocytes.…”

Section: Melanocytic Tumorsmentioning

confidence: 80%

Correlation Between In Vivo Reflectance Confocal Microscopy and Horizontal Histopathology in Skin Cancer: A Review

et al. 2021

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In dermatopathological daily practice, vertical histopathology sections are classically used to analyze skin biopsies. Conversely, horizontal histopathological sections are currently used for the diagnosis of some types of alopecia. In the last years the morphological findings obtained by horizontal histopathology have been correlated to those obtained by in vivo reflectance confocal microscopy which provides the same “point of view” of the skin. This review paper emphasizes the strong matching and correlation between reflectance confocal microscopy images and horizontal histopathology in cutaneous neoplasms, further demonstrating the strong reliability of this innovative, non-invasive technique in the management of skin tumors.

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“…A prospective future study could utilize the recently described method for direct dermoscopy-RCM-histopathology correlation. 21 The histopathological RCM findings are also based on a limited sample and need to be confirmed by a study with a larger data set from multiple centres. Third, we identified collagen bundles under RCM in only a small subset of melanomas with NPN; however, due to the inherent imaging depth limitation of RCM, we cannot exclude the possibility that fibrosis is more common among cases with NPN.…”

Section: Discussionmentioning

confidence: 99%

“…This limitation is largely due to the retrospective design. A prospective future study could utilize the recently described method for direct dermoscopy–RCM–histopathology correlation . The histopathological RCM findings are also based on a limited sample and need to be confirmed by a study with a larger data set from multiple centres.…”

Section: Discussionmentioning

confidence: 99%

A comparative dermoscopic and reflectance confocal microscopy study of naevi and melanoma with negative pigment network

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Mazzoni

et al. 2019

Acad Dermatol Venereol

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Background Negative pigment network (NPN) is a dermoscopic structure observed more frequently among melanomas than naevi. Precise tissue correlates of NPN are still elusive. Objective To describe the reflectance confocal microscopy (RCM) findings underlying NPN in melanocytic neoplasms. Methods We retrospectively identified all melanocytic neoplasms displaying dermoscopic NPN that were imaged with RCM and subsequently biopsied between 2011 and 2015. Images from study lesions (n = 50) were evaluated for dermoscopic and RCM Criteria. Histopathological correlational study was performed in a subset of cases (n = 15). Results The study data set consisted of 21 melanomas (42%) and 29 naevi (58%). Melanomas showed more frequently irregularly shaped globules than naevi (62% vs. 28%, P = 0.03); NPN also tended to be more asymmetrically located among melanomas (86%) than naevi (62%), albeit not significant (P = 0.06). Under RCM, we observed three patterns of dermal papillae (DP): (i) ‘Dark DP’ – whereby DP were devoid of nests and often surrounded by a junctional proliferation as thick‐Rings – this pattern was less common among melanomas (n = 10, 48%) than naevi (n = 23, 79%, P = 0.02); (ii) ‘Bulging DP’ – whereby junctional nests of melanocytes protrude into the DP, often in association with junctional proliferation as Meshwork – with comparable frequency among melanomas (n = 12, 57%) and naevi (n = 23, 79%, P = 0.09) and (iii) ‘Expanded DP’ – whereby junctional and/or dermal nests filled and expanded the DP, often in association with dermal–epidermal junction (DEJ) Clod pattern – seen more commonly among melanomas (n = 15, 71%) than naevi (n = 6, 21%, P < 0.001). Dermoscopy–RCM correlation and comparison to histopathological findings show that the hypo‐pigmented lines of NPN correlate with broadened epidermal retes, which often show overlying surface dells and wedge‐shaped hypergranulosis, while the pigmented globules of NPN correlate with a predominantly‐junctiona of melanocytes along and between the elongated retes. Conclusions Dermoscopic NPN correlates with three DEJ RCM patterns with differing frequency between naevi and melanomas.

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Reflectance Confocal Microscopic and En Face Histopathologic Correlation of the Dermoscopic “Circle Within a Circle” in Lentigo Maligna

Abstract: On physical examination, the proximal nail plate was discontinuous with the distal nail plate on the bilateral first, second, and third toenails. The bilateral first toenails also show the disappearing nail bed (Figure ). 3 These findings are consistent with the diagnosis of onychomadesis.

Cited by 11 publications

References 8 publications

Association of Multiple Aggregated Yellow-White Globules With Nonpigmented Basal Cell Carcinoma

Association of Multiple Aggregated Yellow-White Globules With Nonpigmented Basal Cell Carcinoma

Correlation Between In Vivo Reflectance Confocal Microscopy and Horizontal Histopathology in Skin Cancer: A Review

A comparative dermoscopic and reflectance confocal microscopy study of naevi and melanoma with negative pigment network

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