N G Maher1,2, A Solinas1,3, R A Scolyer1,2,3, S Puig4, G Pellacani5, P Guitera1,2,6. 1. Melanoma Institute Australia, Sydney, NSW, Australia. 2. The University of Sydney, Sydney, NSW, Australia. 3. Tissue Pathology and Diagnostic Oncology, Royal Prince Alfred Hospital, Sydney, NSW, Australia. 4. Melanoma Unit, Dermatology Department, Hospital Clinic of Barcelona, IDIBAPS, Barcelona, Spain. 5. Department of Dermatology, University of Modena and Reggio Emilia, Modena, Italy. 6. Sydney Melanoma Diagnostic Centre, Royal Prince Alfred Hospital, Sydney, NSW, Australia.
Abstract
BACKGROUND: Desmoplastic melanoma (DM) is frequently misdiagnosed clinically and often associated with melanoma in situ (MIS). OBJECTIVE: To improve the detection of DM using dermoscopy and reflectance confocal microscopy (RCM). METHODS: A descriptive analysis of DM dermoscopy features and a case-control study within a melanoma population for RCM feature evaluation was performed blindly, using data obtained between 2005 and 2015. After retrospectively identifying all DM cases with RCM data over the study period (n = 16), a control group of non-DM melanoma patients with RCM data, in a ratio of at least 3 : 1, was selected. The control group was matched by age and primary tumour site location, divided into non-DM invasive melanomas (n = 27) and MIS (n = 27). Invasive melanomas were selected according to the melanoma subtypes associated with the DM cases. The main outcomes were the frequency of melanoma-specific features on dermoscopy for DM; and the odds ratios of RCM features to distinguish DM from MIS and/or other invasive melanomas; or MIS from the combined invasive melanoma group. RESULTS: At least one of the 14 melanoma-specific features evaluated on dermoscopy was found in 100% of DMs (n = 15 DM with dermoscopy). Known RCM melanoma predictors were commonly found in the DMs, such as pagetoid cells (100%) and cell atypia (100%). The RCM feature of spindle cells in the superficial dermis was more common in DM compared with the entire melanoma control group (OR 3.82, 95% CI 1.01-14.90), and particularly compared to MIS (OR 5.48, 95% CI 1.11-32.36). Nucleated cells in the dermis and the RCM correlate of dermal inflammation were also significant RCM features favouring DM over MIS, as well as invasive melanoma over MIS. CONCLUSION: Dermoscopy and RCM may be useful tools for the identification of DM. Certain RCM features may help distinguish DM from MIS and other invasive melanomas. Larger studies are warranted.
BACKGROUND:Desmoplastic melanoma (DM) is frequently misdiagnosed clinically and often associated with melanoma in situ (MIS). OBJECTIVE: To improve the detection of DM using dermoscopy and reflectance confocal microscopy (RCM). METHODS: A descriptive analysis of DM dermoscopy features and a case-control study within a melanoma population for RCM feature evaluation was performed blindly, using data obtained between 2005 and 2015. After retrospectively identifying all DM cases with RCM data over the study period (n = 16), a control group of non-DMmelanomapatients with RCM data, in a ratio of at least 3 : 1, was selected. The control group was matched by age and primary tumour site location, divided into non-DM invasive melanomas (n = 27) and MIS (n = 27). Invasive melanomas were selected according to the melanoma subtypes associated with the DM cases. The main outcomes were the frequency of melanoma-specific features on dermoscopy for DM; and the odds ratios of RCM features to distinguish DM from MIS and/or other invasive melanomas; or MIS from the combined invasive melanoma group. RESULTS: At least one of the 14 melanoma-specific features evaluated on dermoscopy was found in 100% of DMs (n = 15 DM with dermoscopy). Known RCM melanoma predictors were commonly found in the DMs, such as pagetoid cells (100%) and cell atypia (100%). The RCM feature of spindle cells in the superficial dermis was more common in DM compared with the entire melanoma control group (OR 3.82, 95% CI 1.01-14.90), and particularly compared to MIS (OR 5.48, 95% CI 1.11-32.36). Nucleated cells in the dermis and the RCM correlate of dermal inflammation were also significant RCM features favouring DM over MIS, as well as invasive melanoma over MIS. CONCLUSION: Dermoscopy and RCM may be useful tools for the identification of DM. Certain RCM features may help distinguish DM from MIS and other invasive melanomas. Larger studies are warranted.
Authors: Pascale Guitera; Giovanni Pellacani; Kerry A Crotty; Richard A Scolyer; Ling-Xi L Li; Sara Bassoli; Marco Vinceti; Harold Rabinovitz; Caterina Longo; Scott W Menzies Journal: J Invest Dermatol Date: 2010-04-15 Impact factor: 8.551
Authors: Giovanni Pellacani; Caterina Longo; Gerardo Ferrara; Anna Maria Cesinaro; Sara Bassoli; Pascale Guitera; Scott W Menzies; Stefania Seidenari Journal: J Am Acad Dermatol Date: 2008-12-16 Impact factor: 11.527
Authors: Pascale Guitera; Scott W Menzies; Caterina Longo; Anna M Cesinaro; Richard A Scolyer; Giovanni Pellacani Journal: J Invest Dermatol Date: 2012-06-21 Impact factor: 8.551
Authors: Klaus J Busam; Urvi Mujumdar; Amanda J Hummer; Jennifer Nobrega; William G Hawkins; Daniel G Coit; Mary S Brady Journal: Am J Surg Pathol Date: 2004-11 Impact factor: 6.394
Authors: Natalia Jaimes; Lucy Chen; Stephen W Dusza; Cristina Carrera; Susana Puig; Luc Thomas; John W Kelly; Lucy Dang; Iris Zalaudek; Ralph P Braun; Scott W Menzies; Klaus J Busam; Ashfaq A Marghoob Journal: JAMA Dermatol Date: 2013-04 Impact factor: 10.282
Authors: Evan George; Susannah E McClain; Craig L Slingluff; Nayak L Polissar; James W Patterson Journal: J Cutan Pathol Date: 2009-04 Impact factor: 1.587
Authors: Cristian Navarrete-Dechent; Konstantinos Liopyris; Jilliana Monnier; Saud Aleissa; Lindsay M Boyce; Caterina Longo; Margaret Oliviero; Harold Rabinovitz; Ashfaq A Marghoob; Allan C Halpern; Giovanni Pellacani; Alon Scope; Manu Jain Journal: J Am Acad Dermatol Date: 2020-05-23 Impact factor: 11.527