title: Hyporeflective pagetoid cells: a new clue for amelanotic melanoma diagnosis by reflectance confocal microscopy.
abstract: BACKGROUND
  Amelanotic melanoma represents a diagnostic challenge both clinically and dermoscopically. Few studies based on case series have explored the possibility of using reflectance confocal microscopy (RCM) to diagnose amelanotic melanoma.
  
  
  OBJECTIVE
  To validate a new confocal feature, named hyporeflective pagetoid cells (HPCs), for the diagnosis of amelanotic melanoma.
  
  
  METHODS
  A group of 20 amelanotic melanomas and a control population of nonpigmented melanocytic naevi (10), hypo/nonpigmented nonmelanocytic lesions (20) and pigmented melanomas (20), imaged by RCM, were retrospectively evaluated. The presence of HPCs and other diagnosis-specific confocal features was assessed and correlated with histopathology.
  
  
  RESULTS
  HPCs were present, and usually abundant, in the majority of amelanotic melanomas (85%). As expected, they were also observed in Spitz naevi. On histopathology, they were correlated with pagetoid infiltration of hypomelanotic melanocytes in all melanocytic lesions. Few nonmelanocytic lesions (three squamous cell carcinomas, two seborrhoeic keratoses and one basal cell carcinoma) showed the presence of HPCs. In these cases, they corresponded to enlarged or dyskeratotic keratinocytes by histopathology.
  
  
  CONCLUSIONS
  The identification of HPCs in the epidermis is a new parameter that is frequently found in amelanotic melanoma. Possible confounders are represented by atypical keratinocytes that can be present in nonmelanocytic lesions. However, the whole architecture and the presence of additional diagnostic criteria should be considered in order to obtain a correct diagnosis.
authors: Department of Dermatology, University of Modena and Reggio Emilia, Modena, Italy.
authors: A
authors: A
authors: Losi
authors: C
authors: C
authors: Longo
authors: A M
authors: AM
authors: Cesinaro
authors: E
authors: E
authors: Benati
authors: A
authors: A
authors: Witkowski
authors: P
authors: P
authors: Guitera
authors: G
authors: G
authors: Pellacani
mesh_terms: D002294:Carcinoma, Squamous Cell / Q000473:pathology; D016022:Case-Control Studies; D005260:Female; D006801:Humans; D015603:Keratinocytes / Q000473:pathology; D017492:Keratosis, Seborrheic / Q000473:pathology; D008297:Male; D008544:Melanocytes / Q000473:pathology*; D018328:Melanoma, Amelanotic / Q000473:pathology*; D018613:Microscopy, Confocal / Q000379:methods; D008875:Middle Aged; D018332:Nevus, Epithelioid and Spindle Cell / Q000473:pathology; D012189:Retrospective Studies; D012878:Skin Neoplasms / Q000473:pathology*