Detection of Desmoplastic Melanoma with Dermoscopy and Reflectance Confocal Microscopy

Overview

Journal J Eur Acad Dermatol Venereol

Specialty Infectious Diseases

Date 2017 Jun 3

PMID 28573666

Citations 8

Authors

N G Maher

A Solinas

R A Scolyer

S Puig

G Pellacani

P Guitera

Affiliations

Soon will be listed here.

Abstract

Background: Desmoplastic melanoma (DM) is frequently misdiagnosed clinically and often associated with melanoma in situ (MIS).

Objective: To improve the detection of DM using dermoscopy and reflectance confocal microscopy (RCM).

Methods: A descriptive analysis of DM dermoscopy features and a case-control study within a melanoma population for RCM feature evaluation was performed blindly, using data obtained between 2005 and 2015. After retrospectively identifying all DM cases with RCM data over the study period (n = 16), a control group of non-DM melanoma patients with RCM data, in a ratio of at least 3 : 1, was selected. The control group was matched by age and primary tumour site location, divided into non-DM invasive melanomas (n = 27) and MIS (n = 27). Invasive melanomas were selected according to the melanoma subtypes associated with the DM cases. The main outcomes were the frequency of melanoma-specific features on dermoscopy for DM; and the odds ratios of RCM features to distinguish DM from MIS and/or other invasive melanomas; or MIS from the combined invasive melanoma group.

Results: At least one of the 14 melanoma-specific features evaluated on dermoscopy was found in 100% of DMs (n = 15 DM with dermoscopy). Known RCM melanoma predictors were commonly found in the DMs, such as pagetoid cells (100%) and cell atypia (100%). The RCM feature of spindle cells in the superficial dermis was more common in DM compared with the entire melanoma control group (OR 3.82, 95% CI 1.01-14.90), and particularly compared to MIS (OR 5.48, 95% CI 1.11-32.36). Nucleated cells in the dermis and the RCM correlate of dermal inflammation were also significant RCM features favouring DM over MIS, as well as invasive melanoma over MIS.

Conclusion: Dermoscopy and RCM may be useful tools for the identification of DM. Certain RCM features may help distinguish DM from MIS and other invasive melanomas. Larger studies are warranted.

Citing Articles

The Importance of In Vivo Reflectance Confocal Microscopy in a Case of Desmoplastic Melanoma.

Cristescu M, Popa L, Cozma E, Celarel A, Popa V, Lupu M Life (Basel). 2024; 14(5).

PMID: 38792595 PMC: 11122514. DOI: 10.3390/life14050574.

Primary cutaneous melanoma of the scalp: Patterns of clinical, histological and epidemiological characteristics in Brazil.

Porto A, Pinto Blumetti T, de Abranches Oliveira Santos Filho I, Calsavara V, Duprat Neto J, Braga J PLoS One. 2020; 15(10):e0240864.

PMID: 33095773 PMC: 7584174. DOI: 10.1371/journal.pone.0240864.

Diagnostic accuracy of reflectance confocal microscopy for pigmented skin lesions presenting dermoscopic features of cutaneous melanoma.

Podolec K, Pirowska M, Dyduch G, Wojas-Pelc A Postepy Dermatol Alergol. 2020; 37(4):531-534.

PMID: 32994775 PMC: 7507154. DOI: 10.5114/ada.2019.82742.

Reflectance confocal microscopy terminology glossary for melanocytic skin lesions: A systematic review.

Navarrete-Dechent C, Liopyris K, Monnier J, Aleissa S, Boyce L, Longo C J Am Acad Dermatol. 2020; 84(1):102-119.

PMID: 32454102 PMC: 8387955. DOI: 10.1016/j.jaad.2020.05.097.

Desmoplastic melanoma: Demographic and clinicopathological features and disease-specific prognostic factors.

Shi P, Xu Z, Lei X, Yibulayin F, Wushou A Oncol Lett. 2019; 17(6):5619-5627.

PMID: 31186784 PMC: 6507310. DOI: 10.3892/ol.2019.10259.

References

Pellacani G, Longo C, Ferrara G, Cesinaro A, Bassoli S, Guitera P . Spitz nevi: In vivo confocal microscopic features, dermatoscopic aspects, histopathologic correlates, and diagnostic significance. J Am Acad Dermatol. 2008; 60(2):236-47. DOI: 10.1016/j.jaad.2008.07.061. View

Silva V, Ikino J, Sens M, Nunes D, Di Giunta G . Dermoscopic features of thin melanomas: a comparative study of melanoma in situ and invasive melanomas smaller than or equal to 1mm. An Bras Dermatol. 2013; 88(5):712-7. PMC: 3798346. DOI: 10.1590/abd1806-4841.20132017. View

Debarbieux S, Ronger-Salve S, Dalle S, Balme B, Thomas L . Dermoscopy of desmoplastic melanoma: report of six cases. Br J Dermatol. 2008; 159(2):360-3. DOI: 10.1111/j.1365-2133.2008.08687.x. View

Jaimes N, Chen L, Dusza S, Carrera C, Puig S, Thomas L . Clinical and dermoscopic characteristics of desmoplastic melanomas. JAMA Dermatol. 2013; 149(4):413-21. DOI: 10.1001/jamadermatol.2013.2248. View

Guitera P, Menzies S, Longo C, Cesinaro A, Scolyer R, Pellacani G . In vivo confocal microscopy for diagnosis of melanoma and basal cell carcinoma using a two-step method: analysis of 710 consecutive clinically equivocal cases. J Invest Dermatol. 2012; 132(10):2386-2394. DOI: 10.1038/jid.2012.172. View

Guitera P, Pellacani G, Crotty K, Scolyer R, Li L, Bassoli S . The impact of in vivo reflectance confocal microscopy on the diagnostic accuracy of lentigo maligna and equivocal pigmented and nonpigmented macules of the face. J Invest Dermatol. 2010; 130(8):2080-91. DOI: 10.1038/jid.2010.84. View

Pellacani G, Guitera P, Longo C, Avramidis M, Seidenari S, Menzies S . The impact of in vivo reflectance confocal microscopy for the diagnostic accuracy of melanoma and equivocal melanocytic lesions. J Invest Dermatol. 2007; 127(12):2759-65. DOI: 10.1038/sj.jid.5700993. View

Losi A, Longo C, Cesinaro A, Benati E, Witkowski A, Guitera P . Hyporeflective pagetoid cells: a new clue for amelanotic melanoma diagnosis by reflectance confocal microscopy. Br J Dermatol. 2013; 171(1):48-54. DOI: 10.1111/bjd.12781. View

George E, McClain S, Slingluff C, Polissar N, Patterson J . Subclassification of desmoplastic melanoma: pure and mixed variants have significantly different capacities for lymph node metastasis. J Cutan Pathol. 2009; 36(4):425-32. DOI: 10.1111/j.1600-0560.2008.01058.x. View

10.

Busam K, Mujumdar U, Hummer A, Nobrega J, Hawkins W, Coit D . Cutaneous desmoplastic melanoma: reappraisal of morphologic heterogeneity and prognostic factors. Am J Surg Pathol. 2004; 28(11):1518-25. DOI: 10.1097/01.pas.0000141391.91677.a4. View

11.

Pizzichetta M, Argenziano G, Talamini R, Piccolo D, Gatti A, Trevisan G . Dermoscopic criteria for melanoma in situ are similar to those for early invasive melanoma. Cancer. 2001; 91(5):992-7. View

12.

Argenziano G, Soyer H, Chimenti S, Talamini R, Corona R, Sera F . Dermoscopy of pigmented skin lesions: results of a consensus meeting via the Internet. J Am Acad Dermatol. 2003; 48(5):679-93. DOI: 10.1067/mjd.2003.281. View

13.

Murali R, Shaw H, Lai K, McCarthy S, Quinn M, Stretch J . Prognostic factors in cutaneous desmoplastic melanoma: a study of 252 patients. Cancer. 2010; 116(17):4130-8. DOI: 10.1002/cncr.25148. View

14.

Lens M, Newton-Bishop J, Boon A . Desmoplastic malignant melanoma: a systematic review. Br J Dermatol. 2005; 152(4):673-8. DOI: 10.1111/j.1365-2133.2005.06462.x. View

15.

Farnetani F, Scope A, Braun R, Gonzalez S, Guitera P, Malvehy J . Skin Cancer Diagnosis With Reflectance Confocal Microscopy: Reproducibility of Feature Recognition and Accuracy of Diagnosis. JAMA Dermatol. 2015; 151(10):1075-80. DOI: 10.1001/jamadermatol.2015.0810. View

16.

Quinn M, Crotty K, Thompson J, Coates A, OBrien C, McCarthy W . Desmoplastic and desmoplastic neurotropic melanoma: experience with 280 patients. Cancer. 1998; 83(6):1128-35. View

17.

Pellacani G, Longo C, Malvehy J, Puig S, Carrera C, Segura S . In vivo confocal microscopic and histopathologic correlations of dermoscopic features in 202 melanocytic lesions. Arch Dermatol. 2008; 144(12):1597-608. DOI: 10.1001/archderm.144.12.1597. View