Correlation of dermoscopy with in vivo reflectance confocal microscopy of streaks in melanocytic lesions.
OBJECTIVE
To analyze dermoscopically identified streaks by direct correlation with features visualized on reflectance confocal microscopy (RCM).


METHODS
We evaluated by RCM melanocytic lesions showing peripheral streaks on dermoscopy. A digital camera connected to the RCM computer enabled direct analysis of the streaks. The lesions were excised and histopathologically analyzed.


METHODS
Dermatology clinic specializing in pigmented lesions.


METHODS
The study population comprised 7 patients with melanocytic lesions, including 2 melanomas, 4 dysplastic nevi, and 1 compound nevus with spitzoid features.


RESULTS
In 6 of the cases, peripheral streaks were visualized on RCM as confluent aggregates composed of bright, ill-demarcated cells. These aggregates were contiguous with the bright central part of the lesion and appeared to be curving around dermal papillae. Of the 6 lesions, 3 with elongated aggregates visualized on RCM harbored peripheral, elongated nests on histopathologic examination, and 2 with shorter, more ill-defined peripheral aggregates visualized on RCM had smaller, more poorly formed peripheral nests on histopathologic examination. The seventh lesion showed few peripheral streaks on dermoscopy; however, corresponding features visualized on RCM showed discrete, dense, round nests aligned in proximity. We did not recognize in the present series distinguishing characteristics on RCM that could differentiate between the peripheral streaks of malignant melanoma and nevi.


CONCLUSIONS
Direct dermoscopy-RCM correlation is a feasible method to study streaks and may help to improve the classification methods used in dermoscopy. Additional studies with larger series are needed to confirm our findings and may help elucidate the morphologic and biological nature of peripheral streaks.
Scope
Alon
A
Dermatology Service, Department of Medicine, Memorial Sloan-Kettering Cancer Center, 160 E 53rd St, New York, NY 10022, USA.
Gill
Melissa
M
Benveuto-Andrade
Cristiane
C
Halpern
Allan C
AC
Gonzalez
Salvador
S
Marghoob
Ashfaq A
AA
D000293:Adolescent; D000328:Adult; D046169:Dermoscopy; D005260:Female; D006801:Humans; D007091:Image Processing, Computer-Assisted; D008297:Male; D008545:Melanoma / Q000175:diagnosis* / Q000473:pathology; D018613:Microscopy, Confocal; D008875:Middle Aged; D009508:Nevus, Pigmented / Q000175:diagnosis / Q000473:pathology; D011237:Predictive Value of Tests; D012680:Sensitivity and Specificity; D012878:Skin Neoplasms / Q000175:diagnosis* / Q000473:pathology