title: Clinical and dermoscopic characteristics of melanomas on nonfacial chronically sun-damaged skin.
abstract: BACKGROUND
  Melanomas on chronically sun-damaged skin (CSDS) can be difficult to identify and often manifest morphologic features that overlap with benign lesions.
  
  
  OBJECTIVE
  We describe and analyze the clinical and dermoscopic characteristics of melanomas on nonfacial CSDS.
  
  
  METHODS
  Melanoma cases on nonfacial CSDS were retrospectively identified from the biopsy specimen logs of 6 melanoma clinics. Clinical and dermoscopic images were combined into 1 database. Demographics, clinical, dermoscopic, and histopathologic information were analyzed. Descriptive frequencies were calculated.
  
  
  RESULTS
  One hundred eighty-six cases met the inclusion criteria: 142 melanomas in situ (76%) and 39 invasive (21%; mean thickness, 0.49 mm). Lentigo maligna was the most common histopathologic subtype (n = 76; 40.9%). The most frequent dermoscopic structures were granularity (n = 126; 67.7%) and angulated lines (n = 82; 44%). Vascular structures were more frequent in invasive melanomas (56% vs 12% of in situ melanomas). Most manifested 1 of 3 dermoscopic patterns: patchy peripheral pigmented islands, angulated lines, and tan structureless with granularity pattern.
  
  
  CONCLUSIONS
  This was a retrospective study, and evaluators were not blinded to the diagnosis. In addition, interobserver concordance and sensitivity and specificity for dermoscopic structures were not evaluated.
  
  
  CONCLUSIONS
  Outlier lesions manifesting dermoscopic structures, such as granularity, angulated lines, or vessels and any of the 3 described dermoscopic patterns should raise suspicion for melanoma.
authors.affiliation: Dermatology Service, Aurora Skin Cancer Center and Universidad Pontificia Bolivariana, Medellín, Colombia.
authors.forename: Natalia
authors.initials: N
authors.lastname: Jaimes
authors.affiliation: Dermatology Service, Memorial Sloan-Kettering Cancer Center, New York, New York.
authors.forename: Ashfaq A
authors.initials: AA
authors.lastname: Marghoob
authors.affiliation: Skin and Cancer Associates, Plantation, Florida.
authors.forename: Harold
authors.initials: H
authors.lastname: Rabinovitz
authors.affiliation: Department of Dermatology, University Hospital Zürich, Zürich, Switzerland.
authors.forename: Ralph P
authors.initials: RP
authors.lastname: Braun
authors.affiliation: School of Medicine, The University of Queensland, Brisbane, Australia.
authors.forename: Alan
authors.initials: A
authors.lastname: Cameron
authors.affiliation: School of Medicine, The University of Queensland, Brisbane, Australia.
authors.forename: Cliff
authors.initials: C
authors.lastname: Rosendahl
authors.affiliation: Hermit Park Clinic and Skin Cancer Care, Townsville, Australia.
authors.forename: Greg
authors.initials: G
authors.lastname: Canning
authors.affiliation: Northern Rivers Skin Cancer Clinic, Ballina, Australia. Electronic address: jkballina@gmail.com.
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Keir
mesh_terms: D000328:Adult; D017677:Age Distribution; D000368:Aged; D001315:Australia / Q000453:epidemiology; D015331:Cohort Studies; D046169:Dermoscopy / Q000379:methods*; D055088:Early Detection of Cancer / Q000379:methods; D005260:Female; D006801:Humans; D018327:Hutchinson's Melanotic Freckle / Q000453:epidemiology / Q000209:etiology / Q000473:pathology*; D015994:Incidence; D008297:Male; D008545:Melanoma / Q000453:epidemiology / Q000209:etiology / Q000473:pathology*; D008875:Middle Aged; D009361:Neoplasm Invasiveness / Q000473:pathology; D009367:Neoplasm Staging; D011379:Prognosis; D012189:Retrospective Studies; D018570:Risk Assessment; D017678:Sex Distribution; D012878:Skin Neoplasms / Q000453:epidemiology / Q000209:etiology / Q000473:pathology*; D013472:Sunlight / Q000009:adverse effects*; D014466:Ultraviolet Rays / Q000009:adverse effects
keywords: actinic damage; dermoscopy; lentigo maligna; melanoma; sun-damaged skin; ultraviolet radiation