The 'Ugly Duckling' Sign: Identification of the Common Characteristics of Nevi in an Individual as a Basis for Melanoma Screening

Grob, Jean-Jacques; Bonerandi, J. J.

doi:10.1001/archderm.134.1.103-a

Cited by 288 publications

(165 citation statements)

References 3 publications

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“…These unusual large dots and globules appeared to correspond to the large nests seen in the histological sections. Some clinicians pointed out that in patients with multiple melanocytic lesions, the MLNs were very different from all other pigmented lesions, and raised clinical suspicion for melanoma ('the ugly duckling sign' 13 ).…”

Section: Clinical Characteristicsmentioning

confidence: 99%

Histological and genetic evidence for a variant of superficial spreading melanoma composed predominantly of large nests

et al. 2012

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Cutaneous melanomas are characterized by a range of histological appearances, and several morphological variants have been described. In this study, we report a variant of superficial spreading melanoma that is characterized by large, irregular junctional melanocytic nests. The junctional nests varied in shape and size, showed focal tendency to confluence, and were often surrounded by a cuff of epidermal keratinocytes. The melanocytes comprising the nests showed variable cytological atypia. In most of the cases, scant intraepidermal or junctional single melanocytes were seen, and other well-documented diagnostic criteria for melanoma were lacking, and as a result, histological recognition of these tumors as melanoma was difficult. Some cases were associated with an invasive dermal component or showed evidence of sun damage. To provide supporting evidence for malignancy, we analyzed these tumors for genomic aberrations. Using array comparative genomic hybridization (aCGH), we identified multiple genomic aberrations in all analyzed cases. A similar pattern of genomic aberrations was seen in a control group of bona fide superficial spreading melanomas, suggesting that these 'melanomas composed exclusively or predominantly of large nests' are indeed variants of superficial spreading melanoma. Fluorescence in-situ hybridization (FISH) was positive in 40% of the cases. However, using aCGH, the FISH-negative cases showed multiple genomic aberrations in regions that are not covered by FISH. The low sensitivity of the FISH test can be explained by the fact that FISH only evaluates four genomic loci for aberrations, whereas aCGH surveys the entire genome. In summary, we present histological and molecular genetic evidence for a morphological variant of superficial spreading melanoma. Awareness of the histological features will aid in their correct diagnosis as melanoma, and in difficult cases, judicious application of ancillary tests such as aCGH (rather than FISH) will assist accurate diagnosis. Modern Pathology (2012) 25, 838-845; doi:10.1038/modpathol.2012; published online 2 March 2012 Keywords: chromosomal aberrations; comparative genomic hybridization; fluorescence in-situ hybridization; melanocytic tumors; melanoma Cutaneous melanomas are characterized by a diverse range of histological appearances, and several morphological variants have been described. The most common subtypes in histological classification systems are superficial spreading melanoma, nodular melanoma, lentigo maligna melanoma, and acral lentiginous melanoma. 1 Although histological evaluation is a reliable means of accurately classifying melanocytic tumors as benign

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Section: Clinical Characteristicsmentioning

confidence: 99%

Histological and genetic evidence for a variant of superficial spreading melanoma composed predominantly of large nests

et al. 2012

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“…The "ugly duckling" sign is another clinical approach because a pigmented lesion that "looks different from all of its neighbors" may be suspicious for melanoma. 26 The ugly duckling sign has been shown to be sensitive for melanoma detection, even for nondermatologists. 27 The importance of lesion evolution as a cardinal feature of cutaneous melanoma is also well supported.…”

Section: Basic Factors In Early Diagnosismentioning

confidence: 99%

The Evolution of Melanoma Diagnosis: 25 Years Beyond the ABCDs

Rigel

Russak

Friedman

2010

CA: A Cancer Journal for Clinicians

336

274

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Early detection of malignant melanoma remains the key factor in lowering mortality from this cancer. Recognizing the importance of this issue 25 years ago, our group at New York University published in CA: A Cancer Journal for Clinicians the mnemonic "ABCD" to facilitate the early diagnosis of melanoma. Studies have demonstrated the usefulness of this paradigm in enhancing early melanoma diagnosis as a part of clinical examinations, mass screenings, and public education programs. Approaches to melanoma diagnosis have dynamically evolved during the ensuing quarter century. In the 1990s, dermoscopy enabled the recognition of new subsurface features to differentiate between malignant and benign pigmented lesions. During the last decade, new computer-based technologies have improved diagnostic sensitivity and specificity and may result in optimizing lesion selection for biopsy and pathology review. Despite all of the advances in melanoma diagnosis, timely recognition, detection, and rapid treatment of melanoma remain critical. Although pathologic examination remains the gold standard for diagnosis, this cancer has the potential to be diagnosed through noninvasive approaches because of its cutaneous location. From the development of the ABCDs through current attempts that use complex computer algorithms and genetic markers, a clinician's ability to detect melanoma in its earliest form has been augmented. However, a "good clinical eye" is still fundamental to selecting the lesions for evaluation among the sea of those that are prevalent. As current approaches are refined and new techniques are developed, the improved ability to diagnose this cancer will hopefully enhance reaching the goal of reducing melanoma mortality. CA Cancer J Clin 2010;60:301-316.

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“…The ugly duckling sign refers to a melanotic lesion that is atypical beyond the context of surrounding naevi. 10 This lesion should be regarded with suspicion regardless of specific findings. Malignant melanoma can occur anywhere on the skin and is often seen on the back, head and neck (males), lower extremities (females), and the palms and soles (blacks).…”

Section: Pruritic Conditionsmentioning

confidence: 99%

Common skin disorders in the elderly

Omar

2006

South African Family Practice

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Ageing causes a decline in the function of human skin, while factors such as medical conditions, drugs and environmental irritants add to the compromised skin and predispose it to certain conditions. Superimposed on the changes of physiological ageing are changes characterised by chronic sun exposure. Skin neoplasia, whether benign, premalignant or malignant, is more common in the elderly. It is important to identify benign conditions, as it is crucial that lesions with a malignant potential be recognised so that timeous treatment can prevent serious malignancies. Ultraviolet radiation is the major aetiologic factor for the development of skin cancer. Pruritic conditions result from a combination of a declining barrier function and the effects of environmental irritants. Pruritus due to scabies is common in institutionalised older persons. Infective conditions as a result of a combination of altered immunity, predisposing medical conditions (e.g. diabetes) and a variety of drugs used to treat these conditions may affect immune function and homeostasis. Regular scrutiny of the skin will ensure early identification of problems and implementation of a good skin care plan can compensate for failing physiologic function. SA Fam Pract 2006;48(5): 29-34)

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The 'Ugly Duckling' Sign: Identification of the Common Characteristics of Nevi in an Individual as a Basis for Melanoma Screening

Cited by 288 publications

References 3 publications

Histological and genetic evidence for a variant of superficial spreading melanoma composed predominantly of large nests

Histological and genetic evidence for a variant of superficial spreading melanoma composed predominantly of large nests

The Evolution of Melanoma Diagnosis: 25 Years Beyond the ABCDs

Common skin disorders in the elderly

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