title: Melanoma and naevi with a globular pattern: confocal microscopy as an aid for diagnostic differentiation.
abstract: BACKGROUND
  Dermoscopically, one of the most common findings in melanocytic lesions is a globular pattern. A regular globular pattern is a common finding in naevi. Melanoma can also show a globular pattern, with globules typically irregular in size, colour and distribution.
  
  
  OBJECTIVE
  To investigate the likelihood of diagnosing melanoma according to distinct dermoscopic and confocal aspects.
  
  
  METHODS
  Dermoscopic and confocal aspects of 83 excised melanocytic lesions dermoscopically showing globules were analysed.
  
  
  RESULTS
  Our study population included 39 acquired melanocytic naevi, 16 Spitz naevi and 28 melanomas. Univariate analysis showed that regular distribution of globules on dermoscopy is associated with a ninefold lower risk for melanoma, whereas an irregular distribution is associated with an almost 10-fold increased risk for melanoma. Concerning confocal features, dense nests are associated with a fivefold lower risk for melanoma, whereas loosely arranged nests are associated with an almost sixfold risk for melanoma; moreover, the presence of round cells is associated with a 17-fold lower risk for melanoma, whereas pleomorphic cells are associated with an almost 16-fold risk for melanoma.
  
  
  CONCLUSIONS
  So that melanoma is not missed, clinicians should carefully analyse globular lesions in adults, focusing, in particular, on the distribution of globules and on the presence of confocal cytological atypia.
authors.affiliation: Skin Cancer Unit, Arcispedale S. Maria Nuova-IRCCS, Reggio Emilia, Italy.
authors.forename: E
authors.initials: E
authors.lastname: Benati
authors.affiliation: Dermatology Unit, Second University of Naples, Naples, Italy.
authors.forename: G
authors.initials: G
authors.lastname: Argenziano
authors.affiliation: Skin Cancer Unit, Arcispedale S. Maria Nuova-IRCCS, Reggio Emilia, Italy.
authors.forename: A
authors.initials: A
authors.lastname: Kyrgidis
authors.affiliation: Skin Cancer Unit, Arcispedale S. Maria Nuova-IRCCS, Reggio Emilia, Italy.
authors.forename: E
authors.initials: E
authors.lastname: Moscarella
authors.affiliation: Dermatology Unit, University of Modena and Reggio Emilia, Modena, Italy.
authors.forename: S
authors.initials: S
authors.lastname: Ciardo
authors.affiliation: Dermatology Unit, University of Modena and Reggio Emilia, Modena, Italy.
authors.forename: S
authors.initials: S
authors.lastname: Bassoli
authors.affiliation: Dermatology Unit, University of Modena and Reggio Emilia, Modena, Italy.
authors.forename: F
authors.initials: F
authors.lastname: Farnetani
authors.affiliation: Pathology Unit, Arcispedale S. Maria Nuova-IRCCS, Reggio Emilia, Italy.
authors.forename: S
authors.initials: S
authors.lastname: Piana
authors.affiliation: Pathology Unit, University of Modena and Reggio Emilia, Modena, Italy.
authors.forename: A M
authors.initials: AM
authors.lastname: Cesinaro
authors.affiliation: Skin Cancer Unit, Arcispedale S. Maria Nuova-IRCCS, Reggio Emilia, Italy.
authors.forename: A
authors.initials: A
authors.lastname: Lallas
authors.affiliation: Skin Cancer Unit, Arcispedale S. Maria Nuova-IRCCS, Reggio Emilia, Italy.
authors.forename: S
authors.initials: S
authors.lastname: Borsari
authors.affiliation: Dermatology Unit, University of Modena and Reggio Emilia, Modena, Italy.
authors.forename: G
authors.initials: G
authors.lastname: Pellacani
authors.affiliation: Skin Cancer Unit, Arcispedale S. Maria Nuova-IRCCS, Reggio Emilia, Italy.
authors.forename: C
authors.initials: C
authors.lastname: Longo
mesh_terms: D000328:Adult; D003937:Diagnosis, Differential; D055088:Early Detection of Cancer / Q000379:methods; D005260:Female; D006801:Humans; D008297:Male; D008545:Melanoma / Q000473:pathology*; D018613:Microscopy, Confocal; D009508:Nevus, Pigmented / Q000473:pathology*; D012189:Retrospective Studies; D012307:Risk Factors; D012878:Skin Neoplasms / Q000473:pathology*