Dermoscopy and reflectance confocal microscopy of solitary flat pink lesions: A new combined score to diagnose amelanotic melanoma.
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:
04 Apr 2024
04 Apr 2024
Historique:
received:
18
12
2023
accepted:
04
03
2024
medline:
4
4
2024
pubmed:
4
4
2024
entrez:
4
4
2024
Statut:
aheadofprint
Résumé
Differential diagnosis of amelanotic/hypomelanotic melanoma among solitary flat pink lesions is challenging, due to limited clinical and dermoscopic clues. Dermoscopy and reflectance confocal microscopy assessments improve diagnostic accuracy, but their combined capacity among solitary flat pink lesions is yet to be defined. To determine (i) whether diagnostic accuracy is improved with combined dermoscopy and reflectance confocal microscopy, (ii) a model to estimate probability of flat amelanotic/hypomelanotic melanoma among solitary flat pink lesions. A retrospective single-centre study of solitary flat pink lesions, excised for suspected malignancy between 2011 and 2022 was performed. Images were independently evaluated by two dermatologists, blinded to histopathological diagnosis. Diagnostic performance was evaluated on the receiver operating characteristic curve and the area under the curve. Predictive features were identified by univariate and multivariate logistic regression analyses. A final predictive nomogram of independent risk factors was calculated by backward likelihood ratio. Hypothesis being tested was formulated before data collection. A total of 184 patients (87 females, 47.3%) were included; mean age was 57.6 years (19-95). Combined dermoscopy and reflectance confocal microscopy was more sensitive (83%, CI 69.2-92.4 and 91.5%, CI 79.6-97.6) than dermoscopy alone (76.6%, CI 62.0-87.7 and 85.1%, CI 71.7-93.8). Predictive features defined the new model, including linear irregular vessels (4.26-folds, CI 1.5-12.1), peripheral pigment network (6.07-folds, CI 1.83-20.15), remnants of pigmentation (4.3-folds, CI 1.27-14.55) at dermoscopy and atypical honeycomb (9.98-folds, CI 1.91-51.96), disarranged epidermal pattern (15.22-folds, CI 2.18-106.23), dendritic pagetoid cells in the epidermis (3.77-folds, CI 1.25-11.26), hypopigmented pagetoid cells (27.05-folds, CI 1.57-465.5), and dense and sparse nests (3.68-folds, CI 1.24-10.96) in reflectance confocal microscopy. Diagnostic accuracy of the model was high (AUC 0.91). Adjunctive reflectance confocal microscopy increases diagnostic sensitivity of flat amelanotic/hypomelanotic melanoma differential diagnosis. The proposed model requires validation.
Sections du résumé
BACKGROUND
BACKGROUND
Differential diagnosis of amelanotic/hypomelanotic melanoma among solitary flat pink lesions is challenging, due to limited clinical and dermoscopic clues. Dermoscopy and reflectance confocal microscopy assessments improve diagnostic accuracy, but their combined capacity among solitary flat pink lesions is yet to be defined.
OBJECTIVES
OBJECTIVE
To determine (i) whether diagnostic accuracy is improved with combined dermoscopy and reflectance confocal microscopy, (ii) a model to estimate probability of flat amelanotic/hypomelanotic melanoma among solitary flat pink lesions.
METHODS
METHODS
A retrospective single-centre study of solitary flat pink lesions, excised for suspected malignancy between 2011 and 2022 was performed. Images were independently evaluated by two dermatologists, blinded to histopathological diagnosis. Diagnostic performance was evaluated on the receiver operating characteristic curve and the area under the curve. Predictive features were identified by univariate and multivariate logistic regression analyses. A final predictive nomogram of independent risk factors was calculated by backward likelihood ratio. Hypothesis being tested was formulated before data collection.
RESULTS
RESULTS
A total of 184 patients (87 females, 47.3%) were included; mean age was 57.6 years (19-95). Combined dermoscopy and reflectance confocal microscopy was more sensitive (83%, CI 69.2-92.4 and 91.5%, CI 79.6-97.6) than dermoscopy alone (76.6%, CI 62.0-87.7 and 85.1%, CI 71.7-93.8). Predictive features defined the new model, including linear irregular vessels (4.26-folds, CI 1.5-12.1), peripheral pigment network (6.07-folds, CI 1.83-20.15), remnants of pigmentation (4.3-folds, CI 1.27-14.55) at dermoscopy and atypical honeycomb (9.98-folds, CI 1.91-51.96), disarranged epidermal pattern (15.22-folds, CI 2.18-106.23), dendritic pagetoid cells in the epidermis (3.77-folds, CI 1.25-11.26), hypopigmented pagetoid cells (27.05-folds, CI 1.57-465.5), and dense and sparse nests (3.68-folds, CI 1.24-10.96) in reflectance confocal microscopy. Diagnostic accuracy of the model was high (AUC 0.91).
CONCLUSIONS
CONCLUSIONS
Adjunctive reflectance confocal microscopy increases diagnostic sensitivity of flat amelanotic/hypomelanotic melanoma differential diagnosis. The proposed model requires validation.
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Informations de copyright
© 2024 The Authors. Journal of the European Academy of Dermatology and Venereology published by John Wiley & Sons Ltd on behalf of European Academy of Dermatology and Venereology.
Références
Menzies SW, Kreusch J, Byth K, Pizzichetta MA, Marghoob A, Braun R, et al. Dermoscopic evaluation of amelanotic and hypomelanotic melanoma. Arch Dermatol. 2008;144(9):1120–1127.
Strazzulla LC, Li X, Zhu K, Okhovat JP, Lee SJ, Kim CC. Clinicopathologic, misdiagnosis, and survival differences between clinically amelanotic melanomas and pigmented melanomas. J Am Acad Dermatol. 2019;80(5):1292–1298.
Cheung WL, Patel RR, Leonard A, Firoz B, Meehan SA. Amelanotic melanoma: a detailed morphologic analysis with clinicopathologic correlation of 75 cases. J Cutan Pathol. 2012;39(1):33–39.
Shen S, Wolfe R, McLean CA, Haskett M, Kelly JW. Characteristics and associations of high‐mitotic‐rate melanoma. JAMA Dermatol. 2014;150(10):1048–1055.
Gill M, González S. Enlightening the pink: use of confocal microscopy in pink lesions. Dermatol Clin. 2016;34(4):443–458.
Losi A, Longo C, Cesinaro AM, Benati E, Witkowski A, Guitera P, et al. Hyporeflective pagetoid cells: a new clue for amelanotic melanoma diagnosis by reflectance confocal microscopy. Br J Dermatol. 2014;171(1):48–54.
Lan J, Wen J, Cao S, Yin T, Jiang B, Lou Y, et al. The diagnostic accuracy of dermoscopy and reflectance confocal microscopy for amelanotic/hypomelanotic melanoma: a systematic review and meta‐analysis. Br J Dermatol. 2020;183(2):210–219.
Zalaudek I, Giacomel J, Argenziano G, Hofmann‐Wellenhof R, Micantonio T, Di Stefani A, et al. Dermoscopy of facial nonpigmented actinic keratosis. Br J Dermatol. 2006;155(5):951–956.
Giacomel J, Zalaudek I. Pink lesions. Dermatol Clin. 2013;31(4):649–678. ix.
Agero ALC, Taliercio S, Dusza SW, Salaro C, Chu P, Marghoob AA. Conventional and polarized dermoscopy features of dermatofibroma. Arch Dermatol. 2006;142(11):1431–1437.
Fink C, Haenssle HA. Non‐invasive tools for the diagnosis of cutaneous melanoma. Skin Res Technol. 2017;23(3):261–271.
Navarrete‐Dechent C, Liopyris K, Monnier J, Aleissa S, Boyce LM, Longo C, et al. Reflectance confocal microscopy terminology glossary for melanocytic skin lesions: a systematic review. J Am Acad Dermatol. 2021;84(1):102–119.
Witkowski AM, Łudzik J, DeCarvalho N, Ciardo S, Longo C, DiNardo A, et al. Non‐invasive diagnosis of pink basal cell carcinoma: how much can we rely on dermoscopy and reflectance confocal microscopy? Skin Res Technol. 2016;22(2):230–237.
Braga JCT, Scope A, Klaz I, Mecca P, González S, Rabinovitz H, et al. The significance of reflectance confocal microscopy in the assessment of solitary pink skin lesions. J Am Acad Dermatol. 2009;61(2):230–241.
Ferrari F, Bassoli S, Pellacani G, Argenziano G, Cesinaro AM, Longo C. Similar but different: how reflectance confocal microscopy may help in the diagnosis of pink lesions. Dermatology. 2017;233(2–3):212–216.
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):2759–2765.
Longo C, Moscarella E, Argenziano G, Lallas A, Raucci M, Pellacani G, et al. Reflectance confocal microscopy in the diagnosis of solitary pink skin tumours: review of diagnostic clues. Br J Dermatol. 2015;173(1):31–41.
Haspeslagh M, Noë M, De Wispelaere I, Degryse N, Vossaert K, Lanssens S, et al. Rosettes and other white shiny structures in polarized dermoscopy: histological correlate and optical explanation. J Eur Acad Dermatol Venereol. 2016;30(2):311–313.
Minagawa A. Dermoscopy‐pathology relationship in seborrheic keratosis. J Dermatol. 2017;44(5):518–524.
Álvarez‐Salafranca M, Ara M, Zaballos P. Dermoscopy in basal cell carcinoma: An updated review. Actas Dermosifiliogr. 2021;112(4):330–338.
Braun RP, Rabinovitz HS, Oliviero M, Kopf AW, Saurat JH. Dermoscopy of pigmented skin lesions. J Am Acad Dermatol. 2005;52(1):109–121.
Bono A, Maurichi A, Moglia D, Camerini T, Tragni G, Lualdi M, et al. Clinical and dermatoscopic diagnosis of early amelanotic melanoma. Melanoma Res. 2001;11(5):491–494.
Bories N, Dalle S, Debarbieux S, Balme B, Ronger‐Savlé S, Thomas L. Dermoscopy of fully regressive cutaneous melanoma. Br J Dermatol. 2008;158(6):1224–1229.
Guitera P, Menzies SW, Longo C, Cesinaro AM, Scolyer RA, 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.
Papageorgiou V, Apalla Z, Sotiriou E, Papageorgiou C, Lazaridou E, Vakirlis S, et al. The limitations of dermoscopy: false‐positive and false‐negative tumours. J Eur Acad Dermatol Venereol. 2018;32(6):879–888.
Guitera P, Menzies SW, Argenziano G, Longo C, Losi A, Drummond M, et al. Dermoscopy and in vivo confocal microscopy are complementary techniques for diagnosis of difficult amelanotic and light‐coloured skin lesions. Br J Dermatol. 2016;175(6):1311–1319.
Pizzichetta MA, Polesel J, Perrot JL, Rubegni P, Fiorani D, Rizzo A, et al. Amelanotic/hypomelanotic lentigo maligna: Dermoscopic and confocal features predicting diagnosis. J Eur Acad Dermatol Venereol. 2023;37(2):303–310.
Longo C, Guida S, Mirra M, Pampena R, Ciardo S, Bassoli S, et al. Dermoscopy and reflectance confocal microscopy for basal cell carcinoma diagnosis and diagnosis prediction score: a prospective and multicenter study on 1005 lesions. J Am Acad Dermatol. 2024:S0190‐9622(24)00135‐X. https://doi.org/10.1016/j.jaad.2024.01.035
Russo T, Pampena R, Piccolo V, Alfano R, Papageorgiou C, Apalla Z, et al. The prevalent dermoscopic criterion to distinguish between benign and suspicious pink tumours. J Eur Acad Dermatol Venereol. 2019;33(10):1886–1891.
Pellacani G, Farnetani F, Ciardo S, Chester J, Kaleci S, Mazzoni L, et al. Effect of reflectance confocal microscopy for suspect lesions on diagnostic accuracy in melanoma: a randomized clinical trial. JAMA Dermatol. 2022;158(7):754–761.
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(1):131–138.
Cinotti E, Labeille B, Debarbieux S, Carrera C, Lacarrubba F, Witkowski AM, et al. Dermoscopy vs. reflectance confocal microscopy for the diagnosis of lentigo maligna. J Eur Acad Dermatol Venereol. 2018;32(8):1284–1291.
Soglia S, Pérez‐Anker J, Lobos Guede N, Giavedoni P, Puig S, Malvehy J. Diagnostics using non‐invasive technologies in dermatological oncology. Cancers (Basel). 2022;14(23):5886.