Dermoscopic features of thin melanomas: a comparative study
               of melanoma in situ and invasive melanomas smaller than or equal to 1mm

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

doi:10.1590/abd1806-4841.20132017

Acessibilidade / Reportar erro

Brasil

Anais Brasileiros de Dermatologia

Español English

Brasil

Español English

sumário « anterior atual seguinte »

Sumário

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

Dermoscopic features of thin melanomas: a comparative study of melanoma in situ and invasive melanomas smaller than or equal to 1mm^* * Work conducted at the University Hospital of the Federal University of Santa Catarina (HU-UFSC) - Florianópolis (SC), Brazil

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

Authorship SCIMAGO INSTITUTIONS RANKINGS

BACKGROUND:

Dermoscopy allows the early detection of melanomas. The preoperative determination of Breslow index by dermoscopy could be useful in planning the surgical approach and in selecting patients for sentinel lymph node biopsy.

OBJECTIVES:

This study aims at describing the dermoscopic features of thin melanomas and comparing melanomas in situ with invasive melanomas less than or equal to 1 mm thick.

METHODS:

This was an observational retrospective study in which the dermoscopy photographs of 41 thin melanomas were evaluated. Three observers evaluated together 14 dermoscopic criteria.

RESULTS:

Among thin melanomas, the most frequent criteria were presence of asymmetry in two axes in 95% of cases (39 cases), 3 or more colors in 80.4% of cases (33 cases), atypical dots or globules in 58.5% of cases (24 cases) and atypical network or streaks in 53.6% of cases (22 cases). The group of invasive melanomas presented with a higher frequency and statistical significance (p <0.05) 3 or more colors (OR: 16.1), milky red areas (OR: 4.8) and blue-white veil (OR: 20.4), and a greater tendency to have streaks or atypical network (OR: 3.66).

CONCLUSIONS:

Thin melanomas tend to have asymmetry in the two axes, 3 or more colors, atypical dots or globules and atypical network or streaks. Melanomas in situ tend to have up to 2 colors, no blue-white veil and no milky red area. Invasive melanomas tend to have 3 or more colors, a milky red area, blue-white veil, and atypical network or streaks. Further studies are needed to confirm these findings.

Dermoscopy; Melanoma; Skin neoplasms

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%

Sociedade Brasileira de Dermatologia Av. Rio Branco, 39 18. and., 20090-003 Rio de Janeiro RJ, Tel./Fax: +55 21 2253-6747 - Rio de Janeiro - RJ - Brazil
E-mail: revista@sbd.org.br

Acompanhe os números deste periódico no seu leitor de RSS

[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

Brasil

Brasil

Dermoscopic features of thin melanomas: a comparative study of melanoma in situ and invasive melanomas smaller than or equal to 1mm* * Work conducted at the University Hospital of the Federal University of Santa Catarina (HU-UFSC) - Florianópolis (SC), Brazil

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

BACKGROUND:

OBJECTIVES:

METHODS:

RESULTS:

CONCLUSIONS:

Dermoscopic features of thin melanomas: a comparative study of melanoma in situ and invasive melanomas smaller than or equal to 1mm^* * Work conducted at the University Hospital of the Federal University of Santa Catarina (HU-UFSC) - Florianópolis (SC), Brazil