Microscopic in vivo description of cellular architecture of dermoscopic pigment network in nevi and melanomas.
OBJECTIVE
To characterize the microscopic aspects of the dermoscopic pigment network in vivo, by means of confocal scanning laser microscopy.


METHODS
Confocal imaging was performed on melanocytic lesions characterized by pigment network at dermoscopy. Some confocal architectural and cytologic features, as observed at the dermoepidermal junction, were morphologically described and quantified by means of a dedicated program.


METHODS
University medical department.


METHODS
We studied confocal images of 15 melanomas, 15 dermoscopic atypical nevi, and 15 common nevi.


METHODS
Features referring to aspect, size, regularity, homogeneity, and infiltration of dermal papillae and to cellular size, regularity, and atypia were described by 2 observers on confocal images. Mean dermal papillary diameter, mean cell area, and shape irregularity were quantified by drawing papillae and cell contours on confocal images and measured with the use of a computer program.


RESULTS
Pigment network in melanomas consisted of large basal cells that circumscribed small to medium-sized dermal papillae with marked cellular atypia, sometimes infiltrating dermal papillae. On the other hand, common acquired nevi were characterized by lack of atypical cells and edged dermal papillae. Atypical nevi presented intermediate characteristics between clearly benign and malignant lesions.


CONCLUSIONS
Cellular atypia was the most sensitive feature for melanoma diagnosis, whereas the presence of nucleated cells infiltrating dermal papillae was the most specific one.
Pellacani
Giovanni
G
Department of Dermatology, University of Modena and Reggio Emilia, Modena, Italy. pellacani.giovanni@unimo.it
Cesinaro
Anna Maria
AM
Longo
Caterina
C
Grana
Costantino
C
Seidenari
Stefania
S
D001707:Biopsy, Needle; D015331:Cohort Studies; D046169:Dermoscopy; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D007150:Immunohistochemistry; D008297:Male; D008544:Melanocytes / Q000473:pathology / Q000648:ultrastructure; D008545:Melanoma / Q000175:diagnosis / Q000473:pathology* / Q000648:ultrastructure; D018613:Microscopy, Confocal; D009508:Nevus, Pigmented / Q000175:diagnosis / Q000473:pathology* / Q000648:ultrastructure; D011336:Probability; D012494:Sampling Studies; D012680:Sensitivity and Specificity; D012878:Skin Neoplasms / Q000175:diagnosis / Q000473:pathology* / Q000648:ultrastructure; D012880:Skin Pigmentation; D018709:Statistics, Nonparametric