Maria A Pizzichetta1, Renato Talamini2, Ash A Marghoob3, H Peter Soyer4, Giuseppe Argenziano5, Riccardo Bono6, M Teresa Corradin7, Vincenzo De Giorgi8, Marian A Gonzalez9, Isabel Kolm10, Andrew W Kopf11, Joseph Malvehy12, Niccolò Nami13, Margaret Oliviero10, Giovanni Pellacani14, Susana Puig12, Harold Rabinovitz10, Pietro Rubegni13, Stefania Seidenari14, Ignazio Stanganelli15, Andrea Veronesi2, Iris Zalaudek16, Pierfrancesco Zampieri9, Scott W Menzies17. 1. Centro di Riferimento Oncologico, National Cancer Institute, Aviano, Italy. Electronic address: pizzichetta@cro.it. 2. Centro di Riferimento Oncologico, National Cancer Institute, Aviano, Italy. 3. Dermatology Section, Memorial Sloan Kettering Cancer Center, New York, New York. 4. Dermatology Research Center, University of Queensland, School of Medicine, Princess Alexandra Hospital, Brisbane, Australia. 5. Dermatology and Skin Cancer Unit, Arcispedale Santa Maria Nuova, Istituto di Ricovero e Cura a Carattere Scientifico(IRCCS), Reggio Emilia, Italy. 6. Istituto Dermopatico Immacolata, IRCCS, Rome, Italy. 7. Division of Dermatology, Pordenone Hospital, Pordenone, Italy. 8. Department of Dermatology, University of Florence, Florence, Italy. 9. Division of Dermatology, Merano Hospital, Merano, Italy. 10. Department of Dermatology, University of Miami, Miami, Florida. 11. New York University School of Medicine, New York, New York. 12. Melanoma Unit, Department of Dermatology, Hospital Clinic, Institut d'Investigacions Biomediques August Pi i Sunyer, Barcelona, Spain. 13. Department of Dermatology, University of Siena, Siena, Italy. 14. Department of Dermatology, University of Modena and Reggio Emilia, Modena and Reggio Emilia, Italy. 15. Skin Cancer Unit, Istituto Tumori Romagna, Meldola, Italy. 16. Medical University of Graz, Graz, Austria. 17. Sydney Melanoma Diagnostic Center, Royal Prince Alfred Hospital and Discipline of Dermatology, University of Sydney, Sydney, Australia.
Abstract
BACKGROUND: The negative pigment network (NPN) is seen as a negative of the pigmented network and it is purported to be a melanoma-specific structure. OBJECTIVES: We sought to assess the frequency, sensitivity, specificity, and odds ratios (ORs) of NPN between melanoma cases and a group of control lesions. METHODS: Digitalized images of skin lesions from 679 patients with histopathological diagnosis of dermatofibroma (115), melanocytic nevus (220), Spitz nevus (139), and melanoma (205) were retrospectively collected and blindly evaluated to assess the presence/absence of NPN. RESULTS: The frequency of occurrence of NPN was higher in the melanoma group (34.6%) than in Spitz nevus (28.8%), melanocytic nevus (18.2%), and dermatofibroma (11.3%) groups. An OR of 1.8 emerged for the diagnosis of melanoma in the presence of NPN as compared with nonmelanoma diagnosis. Conversely, for melanocytic nevi and dermatofibromas the OR was very low (0.5 and 0.3, respectively). For Spitz nevi the OR of 1.1 was not statistically significant. When comparing melanoma with dermatofibroma, melanocytic nevus, and Spitz nevus, we observed a significantly higher frequency of multicomponent pattern (68.1%), asymmetric pigmentation (92.9%), irregularly distributed NPN (87.3%), and peripheral location of NPN (66.2%) in melanomas. LIMITATIONS: Further studies can provide the precise dermoscopic-histopathologic correlation of NPN in melanoma and other lesions. CONCLUSIONS: The overall morphologic pattern of NPN, such as the irregular distribution and the peripheral location of NPN, along with the multicomponent pattern and the asymmetric pigmentation could be used as additional features in distinguishing melanoma from Spitz nevus and other benign lesions.
BACKGROUND: The negative pigment network (NPN) is seen as a negative of the pigmented network and it is purported to be a melanoma-specific structure. OBJECTIVES: We sought to assess the frequency, sensitivity, specificity, and odds ratios (ORs) of NPN between melanoma cases and a group of control lesions. METHODS: Digitalized images of skin lesions from 679 patients with histopathological diagnosis of dermatofibroma (115), melanocytic nevus (220), Spitz nevus (139), and melanoma (205) were retrospectively collected and blindly evaluated to assess the presence/absence of NPN. RESULTS: The frequency of occurrence of NPN was higher in the melanoma group (34.6%) than in Spitz nevus (28.8%), melanocytic nevus (18.2%), and dermatofibroma (11.3%) groups. An OR of 1.8 emerged for the diagnosis of melanoma in the presence of NPN as compared with nonmelanoma diagnosis. Conversely, for melanocytic nevi and dermatofibromas the OR was very low (0.5 and 0.3, respectively). For Spitz nevi the OR of 1.1 was not statistically significant. When comparing melanoma with dermatofibroma, melanocytic nevus, and Spitz nevus, we observed a significantly higher frequency of multicomponent pattern (68.1%), asymmetric pigmentation (92.9%), irregularly distributed NPN (87.3%), and peripheral location of NPN (66.2%) in melanomas. LIMITATIONS: Further studies can provide the precise dermoscopic-histopathologic correlation of NPN in melanoma and other lesions. CONCLUSIONS: The overall morphologic pattern of NPN, such as the irregular distribution and the peripheral location of NPN, along with the multicomponent pattern and the asymmetric pigmentation could be used as additional features in distinguishing melanoma from Spitz nevus and other benign lesions.
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