Características dermatoscópicas de melanomas finos: estudo comparativo
                  entre melanomas in situ e melanomas invasivos menores ou iguais a
                  1mm

Silva, Vanessa Priscilla Martins da; Ikino, Juliana Kida; Sens, Mariana Mazzochi; Nunes, Daniel Holthausen; Di Giunta, Gabriella

doi:10.1590/abd1806-4841.20132017

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INVESTIGATION • An. bras. dermatol. 88 (5) • Out 2013 • https://doi.org/10.1590/abd1806-4841.20132017 copiar

Características dermatoscópicas de melanomas finos: estudo comparativo entre melanomas in situ e melanomas invasivos menores ou iguais a 1mm

Autoria SCIMAGO INSTITUTIONS RANKINGS

FUNDAMENTOS:

A dermatoscopia propicia o diagnóstico mais precoce do melanoma. A estimativa préoperatória da espessura de Breslow através da dermatoscopia poderia ser útil no planejamento da conduta cirúrgica e seleção dos pacientes para a biópsia de linfonodo sentinela.

OBJETIVOS:

Este estudo objetiva descrever as características dermatoscópicas encontradas em melanomas finos e comparar melanomas in situ com melanomas invasivos menores ou iguais a 1 mm.

MÉTODOS:

Trata-se de estudo observacional, retrospectivo, no qual avaliouse o registro fotográfico da dermatoscopia de 41 melanomas finos. Três observadores avaliaram em conjunto 14 critérios dermatoscópicos.

RESULTADOS:

Dentre os melanomas finos, os critérios mais encontrados foram: presença de assimetria nos dois eixos em 95% (39 casos), 3 ou mais cores em 80,4% (33 casos), pontos ou glóbulos atípicos em 58,5% (24 casos) e rede atípica ou estrias radiadas em 53,6% (22 casos). O grupo dos melanomas invasivos apresentou com maior frequência e significância estatística (p<0,05) a presença de 3 ou mais cores (OR: 16,1), áreas vermelho-leitosas (OR: 4,8) e véu (OR: 20,4), além de uma maior tendência em apresentar rede atípica ou estrias radiadas (OR: 3,66).

CONCLUSÕES:

Os melanomas finos tendem a apresentar assimetria nos dois eixos, 3 ou mais cores, pontos ou glóbulos atípicos e rede atípica ou estrias radiadas. Os melanomas in situ tendem a apresentar até 2 cores, ausência de véu e de área vermelho-leitosa. Os melanomas invasivos tendem a exibir 3 cores ou mais, área vermelho-leitosa, véu, rede atípica ou estrias radiadas. Outros estudos são necessários para a confirmação dos achados.

Dermoscopia; Melanoma; Neoplasias cutâneas

Criterion	Definition
Asymmetry in two axes	In 0, 1 or 2 perpendicular axes; assess not only contour, but also colors and structures.¹²12. Argenziano G, Soyer HP, Chimenti S, Talamini R, Corona R, Sera F, et al. Dermoscopy of pigmented skin lesions: results of a consensus meeting via the Internet. J Am Acad Dermatol. 2003;48:679-93.
Atypical dots/ globules	Black, brown, round to oval, various sizes, irregularly distributed within the lesion.¹²12. Argenziano G, Soyer HP, Chimenti S, Talamini R, Corona R, Sera F, et al. Dermoscopy of pigmented skin lesions: results of a consensus meeting via the Internet. J Am Acad Dermatol. 2003;48:679-93.
Atypical network	Black, brown or gray network with irregular holes and thick lines.¹²12. Argenziano G, Soyer HP, Chimenti S, Talamini R, Corona R, Sera F, et al. Dermoscopy of pigmented skin lesions: results of a consensus meeting via the Internet. J Am Acad Dermatol. 2003;48:679-93.
Streaks	Linear structures of brown to black color, of variable thickness, not clearly combined with the lines of the network. It is most evident in the periphery.¹⁵15. Soyer HP, Argenziano G, Chimenti S, Ruocco V. Dermoscopy of pigmented skin lesions. Eur J Dermatol. 2001;11:270-6.
Pseudopods	Bulbous and often kinked projections that are found at the edge of a lesion, either directly connected to the tumor body or pigmented network. They can never be seen distributed regularly or symmetrically around the lesion. When connected directly to the tumor body, they must have an acute angle to the tumor edge or arise from linear or curvilinear extensions. When connected to the network, the width of the bulbous ending must be greater than the width of any part of the surrounding network and at least double that of its direc- tly connected network projection.¹²12. Argenziano G, Soyer HP, Chimenti S, Talamini R, Corona R, Sera F, et al. Dermoscopy of pigmented skin lesions: results of a consensus meeting via the Internet. J Am Acad Dermatol. 2003;48:679-93.
Blotches	Black, brown, and/or gray structureless areas with symmetrical or asymmetrical distribution within the lesion. ¹²12. Argenziano G, Soyer HP, Chimenti S, Talamini R, Corona R, Sera F, et al. Dermoscopy of pigmented skin lesions: results of a consensus meeting via the Internet. J Am Acad Dermatol. 2003;48:679-93.

Blue-white veil	Irregular, structureless area of confluent blue pigmentation with an overlying white "ground-glass" film. The pigmentation cannot cover the entire lesion and usually corresponds to a clinically elevated part of the lesion.¹²12. Argenziano G, Soyer HP, Chimenti S, Talamini R, Corona R, Sera F, et al. Dermoscopy of pigmented skin lesions: results of a consensus meeting via the Internet. J Am Acad Dermatol. 2003;48:679-93.
Structureless area	Area with absence of structures larger than 10% of the total lesion. ¹⁶16. Stolz W, Semmelmayer U, Johow K, Burgdorf WHC. Principles of dermatoscopy of pigmented skin lesions. Semin Cutan Med Surg. 2003;22:9-20.
Atypical vessels	Linear-irregular or dotted vessels not clearly seen within regression structures. ¹²12. Argenziano G, Soyer HP, Chimenti S, Talamini R, Corona R, Sera F, et al. Dermoscopy of pigmented skin lesions: results of a consensus meeting via the Internet. J Am Acad Dermatol. 2003;48:679-93.
Milky red area	Globules and/or larger areas of fuzzy or unfocused milky-red color usually corresponding to an elevated part of the lesion. ¹⁴14. Argenziano G, Zalaudek I, Corona R, Sera F, Cicale L, Petrillo G, et al. Vascular structures in skin tumors: a dermoscopy study. Arch Dermatol. 2004;140:1485-9.

Island	Well-circumscribed area which shows a uniform dermoscopic pattern, different from the rest of the pigmen- ted lesion. ¹³13. Borsari S, Longo C, Ferrari C, Benati E, Bassoli S, Schianchi S, et al. Dermoscopic island: a new descriptor for thin melanoma. Arch Dermatol. 2010;146:1257-62.

Peppering	Foci of multiple blue or gray dots (not globules) often described as "pepper-like" granules in pattern.¹²12. Argenziano G, Soyer HP, Chimenti S, Talamini R, Corona R, Sera F, et al. Dermoscopy of pigmented skin lesions: results of a consensus meeting via the Internet. J Am Acad Dermatol. 2003;48:679-93.
White like-scar area	Areas of white distinct irregular extensions (true scarring), which should not be confused with hypo- or depigmentation due to simple loss of melanin. ¹²12. Argenziano G, Soyer HP, Chimenti S, Talamini R, Corona R, Sera F, et al. Dermoscopy of pigmented skin lesions: results of a consensus meeting via the Internet. J Am Acad Dermatol. 2003;48:679-93.

	Melanomas in situ		Invasive melanomas		Thin melanomas		OR (CI 95%)	p value
Criterion	(total 17)		(total 24)		(total 41)
	N	%	N	%	N	%
Atypical network or streaks	6	35.3%	16	66.7%	22	53.6%	3.66 (0.99-13.56)	p=0.047
Blue-white veil	0	0%	9	37.5%	9	22%	20.4 (1.08-382.4)	p=0.017^* * with statistical significance
Milky red area	5	29.4%	16	66.7%	21	51.2%	4.8 (1.25-18.42)	p=0.028^* * with statistical significance
Colors (3 or more)	10	58.8%	23	95.8%	33	80.4%	16.1 (1.74-148.7)	p<0.01^* * with statistical significance
Asymmetry in two axes	16	94.1%	23	95.8%	39	95.1%
Atypical dots or atypical globules	10	58.8%	14	58.3%	24	58.5%
Pseudopods	0	0%	2	8.3%	2	4.9%
Blotches	0	0%	1	4.2%	1	2.4%
Structureless area	11	64.7%	10	41.7%	21	51.2%
Atypical vessels	5	29.4%	8	33.3%	13	31.7%
Island	2	11.8%	1	4.2%	3	7.3%
Peppering	0	0%	3	12.5%	3	7.3%
White like-scar area	2	11.8%	2	8.3%	4	9.8%

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[1] MAILING ADDRESS: Vanessa Priscilla Martins da Silva, Hospital Universitário - Serviço de Dermatologia, Rua Maria Flora Pausenwang, s/n. - Campus Universitário, Trindade 88040-900 - Florianópolis - SC, Brazil, E-mail: med.nessa@gmail.com