A comparative dermoscopic and reflectance confocal microscopy study of naevi and melanoma with negative pigment network.
Journal
Journal of the European Academy of Dermatology and Venereology : JEADV
ISSN: 1468-3083
Titre abrégé: J Eur Acad Dermatol Venereol
Pays: England
ID NLM: 9216037
Informations de publication
Date de publication:
Dec 2019
Dec 2019
Historique:
received:
17
02
2019
accepted:
27
05
2019
pubmed:
10
7
2019
medline:
28
5
2020
entrez:
9
7
2019
Statut:
ppublish
Résumé
Negative pigment network (NPN) is a dermoscopic structure observed more frequently among melanomas than naevi. Precise tissue correlates of NPN are still elusive. To describe the reflectance confocal microscopy (RCM) findings underlying NPN in melanocytic neoplasms. We retrospectively identified all melanocytic neoplasms displaying dermoscopic NPN that were imaged with RCM and subsequently biopsied between 2011 and 2015. Images from study lesions (n = 50) were evaluated for dermoscopic and RCM Criteria. Histopathological correlational study was performed in a subset of cases (n = 15). The study data set consisted of 21 melanomas (42%) and 29 naevi (58%). Melanomas showed more frequently irregularly shaped globules than naevi (62% vs. 28%, P = 0.03); NPN also tended to be more asymmetrically located among melanomas (86%) than naevi (62%), albeit not significant (P = 0.06). Under RCM, we observed three patterns of dermal papillae (DP): (i) 'Dark DP' - whereby DP were devoid of nests and often surrounded by a junctional proliferation as thick-Rings - this pattern was less common among melanomas (n = 10, 48%) than naevi (n = 23, 79%, P = 0.02); (ii) 'Bulging DP' - whereby junctional nests of melanocytes protrude into the DP, often in association with junctional proliferation as Meshwork - with comparable frequency among melanomas (n = 12, 57%) and naevi (n = 23, 79%, P = 0.09) and (iii) 'Expanded DP' - whereby junctional and/or dermal nests filled and expanded the DP, often in association with dermal-epidermal junction (DEJ) Clod pattern - seen more commonly among melanomas (n = 15, 71%) than naevi (n = 6, 21%, P < 0.001). Dermoscopy-RCM correlation and comparison to histopathological findings show that the hypo-pigmented lines of NPN correlate with broadened epidermal retes, which often show overlying surface dells and wedge-shaped hypergranulosis, while the pigmented globules of NPN correlate with a predominantly-junctiona of melanocytes along and between the elongated retes. Dermoscopic NPN correlates with three DEJ RCM patterns with differing frequency between naevi and melanomas.
Sections du résumé
BACKGROUND
BACKGROUND
Negative pigment network (NPN) is a dermoscopic structure observed more frequently among melanomas than naevi. Precise tissue correlates of NPN are still elusive.
OBJECTIVE
OBJECTIVE
To describe the reflectance confocal microscopy (RCM) findings underlying NPN in melanocytic neoplasms.
METHODS
METHODS
We retrospectively identified all melanocytic neoplasms displaying dermoscopic NPN that were imaged with RCM and subsequently biopsied between 2011 and 2015. Images from study lesions (n = 50) were evaluated for dermoscopic and RCM Criteria. Histopathological correlational study was performed in a subset of cases (n = 15).
RESULTS
RESULTS
The study data set consisted of 21 melanomas (42%) and 29 naevi (58%). Melanomas showed more frequently irregularly shaped globules than naevi (62% vs. 28%, P = 0.03); NPN also tended to be more asymmetrically located among melanomas (86%) than naevi (62%), albeit not significant (P = 0.06). Under RCM, we observed three patterns of dermal papillae (DP): (i) 'Dark DP' - whereby DP were devoid of nests and often surrounded by a junctional proliferation as thick-Rings - this pattern was less common among melanomas (n = 10, 48%) than naevi (n = 23, 79%, P = 0.02); (ii) 'Bulging DP' - whereby junctional nests of melanocytes protrude into the DP, often in association with junctional proliferation as Meshwork - with comparable frequency among melanomas (n = 12, 57%) and naevi (n = 23, 79%, P = 0.09) and (iii) 'Expanded DP' - whereby junctional and/or dermal nests filled and expanded the DP, often in association with dermal-epidermal junction (DEJ) Clod pattern - seen more commonly among melanomas (n = 15, 71%) than naevi (n = 6, 21%, P < 0.001). Dermoscopy-RCM correlation and comparison to histopathological findings show that the hypo-pigmented lines of NPN correlate with broadened epidermal retes, which often show overlying surface dells and wedge-shaped hypergranulosis, while the pigmented globules of NPN correlate with a predominantly-junctiona of melanocytes along and between the elongated retes.
CONCLUSIONS
CONCLUSIONS
Dermoscopic NPN correlates with three DEJ RCM patterns with differing frequency between naevi and melanomas.
Types de publication
Comparative Study
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
2273-2282Informations de copyright
© 2019 European Academy of Dermatology and Venereology.
Références
Menzies SW, Ingvar C, McCarthy WH. A sensitivity and specificity analysis of the surface microscopy features of invasive melanoma. Melanoma Res 1996; 6: 55-62.
Braun RP, Scope A, Marghoob AA, Kerl K, Rabinovitz HS, Malvehy J. Histopathologic tissue correlations of dermoscopic structures. In: Marghoob AA, Malvehy J, Braun RP, eds. Atlas of dermoscopy, 2nd edn. Informa Healthcare, London, UK, 2012: 10-32.
Pizzichetta MA, Canzonieri V, Soyer PH, Rubegni P, Talamini R, Massone C. Negative pigment network and shiny white streaks: a dermoscopic-pathological correlation study. Am J Dermatopathol 2014; 36: 433-438.
Kittler H, Marghoob AA, Argenziano G et al. Standardization of terminology in dermoscopy/dermatoscopy: results of the third consensus conference of the International Society of Dermoscopy. J Am Acad Dermatol 2016; 74: 1093-1106.
Pizzichetta MA, Talamini R, Marghoob AA, Soyer HP, Argenziano G, Bono R. Negative Pigment Network: an additional dermoscopic feature for the diagnosis of melanoma. J Am Acad Dermatol 2013; 68: 552-559.
Bassoli S, Ferrari C, Borsari S et al. Negative pigment network identifies a peculiar melanoma subtype and represents a clue to melanoma diagnosis: a dermoscopic study of 401 melanomas. Acta Derm Venereol 2013; 93: 650-655.
Merkel EA, Amin SM, Lee CY et al. The utility of dermoscopy-guided histologic sectioning for the diagnosis of melanocytic lesions: a case-control study. J Am Acad Dermatol 2016; 74: 1107-1113.
Lozzi GP, Piccolo D, Micantonio T, Altamura D, Peris K. Early melanomas dermoscopically characterized by reticular depigmentation. Arch Dermatol 2007; 143: 808-809.
Botella-Estrada R, Requena C, Traves V, Nagore E, Guillen C. Chrysalis and negative pigment network in Spitz nevi. Am J Dermatopathol 2012; 34: 188-191.
Rajadhyaksha M, Grossman M, Esterowitz D, Webb RH, Anderson RR. In vivo confocal scanning laser microscopy of human skin: melanin provides strong contrast. J Invest Dermatol 1995; 104: 946-952.
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: 2759-2765.
Guitera P, Pellacani G, Longo C, Seidenari S, Avramidis M, Menzies SW. In vivo reflectance confocal microscopy enhances secondary evaluation of melanocytic lesions. J Invest Dermatol 2009; 129: 131-138.
Pellacani G, Longo C, Malvehy J et al. In vivo confocal microscopic and histopathologic correlations of dermoscopic features in 202 melanocytic lesions. Arch Dermatol 2008; 144: 1597-1608.
Scope A, Benvenuto-Andrade C, Agero AL, Halpern AC, Gonzalez S, Marghoob AA. Correlation of dermoscopic structures of melanocytic lesions to reflectance confocal microscopy. Arch Dermatol 2007; 143: 176-185.
Pellacani G, Cesinaro AM, Longo C, Grana C, Seidenari S. Microscopic in vivo description of cellular architecture of dermoscopic pigment network in nevi and melanomas. Arch Dermatol 2005; 141: 147-154.
Gill M, Longo C, Farnetani F, Cesinaro AM, González S, Pellacani G. Non-invasive in vivo dermatopathology: identification of reflectance confocal microscopic correlates to specific histological features seen in melanocytic neoplasms. J Eur Acad Dermatol Venereol 2014; 28: 1069-1078.
Scope A, Gill M, Benveuto-Andrade C, Halpern AC, Gonzalez S, Marghoob AA. Correlation of dermoscopy with in vivo reflectance confocal microscopy of streaks in melanocytic lesions. Arch Dermatol 2007; 143: 727-734.
De Pace B, Farnetani F, Losi A et al. Reinterpreting dermoscopic pigment network with reflectance confocal microscopy for identification of melanoma-specific features. J Eur Acad Dermatol Venereol 2018; 32: 947-955.
Farnetani F, Scope A, Braun RP et al. Skin cancer diagnosis with reflectance confocal microscopy: reproducibility of feature recognition and accuracy of diagnosis. JAMA Dermatol 2015; 151: 1075-1080.
Pellacani G, Scope A, Farnetani F et al. Towards an in vivo morphologic classification of melanocytic nevi. J Eur Acad Dermatol Venereol 2014; 28: 864-872.
Navarrete-Dechent C, Liopyris K, Cordova M, Busam KJ, Marghoob AA, Chen CJ. Reflectance confocal microscopic and en face histopathologic correlation of the dermoscopic “circle within a circle” in lentigo maligna. JAMA Dermatol 2018; 154: 1092-1094.