Early stages of melanoma on the limbs of high-risk patients: clinical, dermoscopic, reflectance confocal microscopy and histopathological characterization for improved recognition.
Early stages of 36 melanomas on limbs were morphologically characterised. Most occurred in high-risk patients (multiple and/or familial melanoma) attending a referral unit for melanoma and pigmented lesions. None of the tumours was clinically suspicious for melanoma (mean diameter of 4.3 mm). The tumours were classified into four dermoscopic groups: (i) prominent network (n = 16); (ii) delicate network (n = 5); (iii) hypo-pigmentation with dotted vessels (n = 10); and (iv) diffuse light pigmentation with perifollicular pigmentation (n = 5). Confocal microscopy performed in 12 cases allowed the identification of atypical, single cells within epidermal layers. Histopathology showed marked large atypical cells in a pagetoid spreading pattern in most cases. Significant associations were detected between the third dermoscopic group and naevoid histological appearance and delay in detection, and between the fourth group and lentigo-maligna-like features. Dermoscopy allowed an increase in the suspicious threshold in these difficult melanomas in high-risk patients and enabled the subclassification of early melanomas on the limbs, with a correct confocal and histopathological correlation. Although the biological behaviour of these incipient tumours remains uncertain, the most appropriate treatment seems to be recognition and proper excision.
Department of Dermatology, Melanoma and Dermatopathology Units, Hospital Clínic de Barcelona, Universitat de Barcelona, Barcelona, Spain. criscarrer@yahoo.es
Cristina
C
Carrera
Josep
J
Palou
Josep
J
Malvehy
Sonia
S
Segura
Paula
P
Aguilera
Gabriel
G
Salerni
Louise
L
Lovatto
Joan
J
Puig-Butillé
Llucia
L
Alós
Susana
S
Puig
D000328:Adult; D000368:Aged; D046169:Dermoscopy; D004416:Dysplastic Nevus Syndrome / Q000473:pathology; D005121:Extremities / Q000473:pathology; D005260:Female; D020022:Genetic Predisposition to Disease; D006801:Humans; D008297:Male; D008545:Melanoma / Q000235:genetics / Q000473:pathology*; D018613:Microscopy, Confocal / Q000379:methods; D008875:Middle Aged; D016609:Neoplasms, Second Primary / Q000473:pathology; D011230:Precancerous Conditions / Q000473:pathology; D012189:Retrospective Studies; D012307:Risk Factors; D012878:Skin Neoplasms / Q000235:genetics / Q000473:pathology*