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Table of Contents
Vol. 224, No. 3, 2012
Issue release date: July 2012
Dermatology 2012;224:262–270
(DOI:10.1159/000338696)

Variegated Dermoscopy of in situ Melanoma

Seidenari S.a · Bassoli S.a · Borsari S.a · Ferrari C.a · Giusti F.a · Ponti G.a · Tomasini C.b · Magnoni C.a
aDepartment of Dermatology, University of Modena, Modena, and bDepartment of Laboratory Diagnostics, Human Pathology, IV Service, San Giovanni Battista University Hospital, Turin, Italy
email Corresponding Author

Abstract

Background: Melanomas in situ (MIS) are difficult to diagnose, lacking well-established dermoscopic descriptors. Objective: The aim of this study was to improve the identification of early melanomas describing the variegated dermoscopic features of MIS and their correlation with demographic and clinical aspects. Methods: Dermoscopic images of 114 histologically proven MIS were evaluated by 3 expert dermoscopists and classified into their main dermoscopic patterns. Dermoscopic features were also considered for their correlation with clinical parameters. Results: Eight different dermoscopic subtypes of MIS were identified: reticular grey-blue (27.2%), reticular (21.1%), multicomponent (20.2%), island (10.5%), spitzoid (7%), inverse network (6.1%), ‘net-blue globules’ (5.3%) and globular (2.6%). Clinical characteristics of lesions and patients varied according to the different dermoscopic groups. Conclusion: We hypothesize that the different dermoscopic subgroups of MIS correspond to lesions with a different origin and, possibly, various patterns of growth and a different biological behaviour.


 Outline


 goto top of outline Key Words

  • Thin melanoma
  • Dermatoscopy
  • Melanoma subtypes
  • Early diagnosis

 goto top of outline Abstract

Background: Melanomas in situ (MIS) are difficult to diagnose, lacking well-established dermoscopic descriptors. Objective: The aim of this study was to improve the identification of early melanomas describing the variegated dermoscopic features of MIS and their correlation with demographic and clinical aspects. Methods: Dermoscopic images of 114 histologically proven MIS were evaluated by 3 expert dermoscopists and classified into their main dermoscopic patterns. Dermoscopic features were also considered for their correlation with clinical parameters. Results: Eight different dermoscopic subtypes of MIS were identified: reticular grey-blue (27.2%), reticular (21.1%), multicomponent (20.2%), island (10.5%), spitzoid (7%), inverse network (6.1%), ‘net-blue globules’ (5.3%) and globular (2.6%). Clinical characteristics of lesions and patients varied according to the different dermoscopic groups. Conclusion: We hypothesize that the different dermoscopic subgroups of MIS correspond to lesions with a different origin and, possibly, various patterns of growth and a different biological behaviour.

Copyright © 2012 S. Karger AG, Basel


goto top of outline Introduction

The aim of each dermoscopist is to detect melanoma (MM) at an early stage, possibly when it has not already invaded the dermis. However, some evidence has been provided that dermoscopy has limitations when considering initial MMs [1]. In fact, while dermoscopic descriptors for invasive MMs have been well established [2], melanomas in situ (MIS), which are characterized histopathologically by the presence of atypical melanocytes within the epidermis and/or epithelial structures of adnexa, have rarely been the object of dermoscopic reports.

Pizzichetta et al. [3] performed a study on 37 MIS, employing dermoscopy and pattern analysis to evaluate whether a diagnosis of MIS can be achieved using the classic dermoscopic MM-specific criteria. The dermoscopic criteria for MIS most frequently observed were blue-whitish veil, grey-blue areas, black dots and peripheral structures, whereas there was no evidence of white scar-like areas or atypical vascular patterns, characteristic of thicker MMs.

In a series of 103 in situ or early invasive MMs with inconspicuous features at the baseline consultation, that were excised after a follow-up of 1 year because of changes, the most frequent baseline characteristics were asymmetric pigmentation, reticular overall pattern and regression features [4]. Thin MMs, however, especially when in situ, are difficult to diagnose [5] and, although sequential dermoscopy imaging allows the detection of MMs which lack dermoscopic features at baseline [6,7], it is not always applicable and, furthermore, it is entirely based on the patient’s compliance [8]. Thus, it would be ideal to have at one’s disposal dermoscopic criteria dedicated to the detection of very early MMs, enabling the identification of in situ lesions at the first examination.

On reviewing our files, we observed that in half of the MIS, localized outside the head/scalp area, the network represents the main dermoscopic pattern and the basic diagnostic criterion. In a recent study describing the network in MIS with a reticular pattern, we found that an atypical network involving more than half of the lesion area, the contemporary presence of more than one type of network, and reticular grey-blue areas which extended over more than half of the lesion were typical descriptors of MIS, differentiating them from atypical naevi [9]. However, in another 50% of our MIS only small portions of net are detectable and the diagnosis has to be based on other dermoscopic aspects.

To study the dermoscopic aspects of MIS and correlate them to clinical data, we collected the images of all MIS recorded during the 2003–2009 period at the Department of Dermatology of the University of Modena together with information obtained from the files of our patients.

Our aim was to identify different subgroups of MIS according to their dermoscopic features, possibly characterizing lesions with a different origin, a different biological potential and a different clinical behaviour.

 

goto top of outline Materials and Methods

The study was carried out with the permission of the Ethics Committee of our hospital (Policlinico of Modena) and data were collected according to Protocol No. 1338/C.E.

Dermoscopic images were recorded by means of a digital video microscope (FotoFinder, TeachScreen Software GmbH, Bad Birnbach, Germany), using a 20- and 50-fold magnification. The instrument and the calibration method have already been described elsewhere [10]. Images at a 20-fold magnification were used to perform diameter measurements, whereas 50-fold magnified images were employed to describe the dermoscopic aspects of the lesions. A total of 865 20-fold, 30-fold and 50-fold magnified dermoscopic images, belonging to 114 consecutive MIS excised from 2003 to 2009 at the Dermatology Department of the University of Modena and Reggio Emilia, were evaluated. Acral, facial and mucosal lesions were excluded for their site-specific dermoscopic aspects. Specimens with the histological diagnosis of MIS were reviewed by a trained dermatopathologist for confirmation of the diagnosis and the presence/absence of a coexisting naevus. Only lesions achieving a second diagnosis of MIS were included in the study. Lesion images were first evaluated to find appropriate dermoscopic patterns for MIS. Afterwards, the same images were reviewed and classified.

Images of MIS were first examined by 3 expert dermoscopists (S.S., C.F. and S.B.) to find appropriate descriptors for main patterns listed in table 1. Subsequently, images were separately evaluated by the 3 observers who assigned them to the corresponding dermoscopic group (fig. 1). The lesion was definitely attributed to a group when at least 2 observers agreed.

TAB01
Table 1. Dermoscopic groups of MIS

FIG01
Fig. 1. The eight dermoscopic subtypes described in our study. a Reticular pattern. ×30. b Reticular grey-blue pigmentation. ×20. c Multicomponent pattern. ×20. d Dermoscopic island pattern. ×20. e Spitzoid pattern. ×20. f Inverse network pattern. ×20. g Net-grey-blue globule pattern. ×20. h Globular pattern. ×50.

Lesions mainly consisting of a network were classified as ‘reticular’. Lesions with reticular regression involving more than half of the lesion area were separately considered and included in a group called ‘reticular grey-blue’. The term reticular regression indicates a coarse blue-grey net, with thick grey-blue lines and large holes, corresponding to white, pink or light brown regression areas [11]. In lesions showing this aspect, the reticulation does not correspond to the pigment network, which has smaller meshes and thinner lines. In some lesions the classic network and reticular grey-blue areas coexist, whereas other lesions, where the regression process prevails, appear entirely surrounded by reticular grey-blue areas. The ‘multicomponent’ pattern included lesions with the contemporary presence of network, globules and structureless areas. In the group ‘island’, we included lesions containing a well-circumscribed lesion area, showing a uniform dermoscopic pattern differing from the one present in the rest of the lesion [12]. The ‘spitzoid’ group consisted of lesions with a spitzoid dermoscopic aspect [13]. When reticular depigmentation was present in at least half of the lesion area, MIS were included in the group ‘inverse network’ [14]. We also identified a small subset of MIS characterized by a dark colour, the presence of a network at the periphery and grey-blue globules in the centre of the lesion (‘net-grey-blue globules’). Finally, only 3 MIS mainly composed of light brown globules were identified (‘globular’).

To evaluate pigment distribution, we employed the classic description of Hofmann-Wellenhof et al. [15]. We also used the term ‘non-homogeneous pigment distribution’ to define an irregular pigmentation characterized by areas of faint hyper- or hypopigmentation, without a really patchy aspect as in the multifocal naevus type, and ‘asymmetric pigment distribution’ for lesions consisting of 2 parts with the same extension and with a different intensity of pigmentation (fig. 2). Once established, the list of descriptors as illustrated in the tables was evaluated by the investigators on 50-fold magnified images. Each descriptor was considered present when at least 2 observers agreed. Moreover, the ABCD and 7-point checklist scores were calculated [16,17]. According to these semiquantitative algorithms, lesions with a total dermoscopy score and a 7-point score higher than 5.45 and 2, respectively, are considered malignant. The diameters of the lesions were measured on digital images employing dedicated software.

FIG02
Fig. 2. Dermoscopic variants. a Lesion with non-homogeneous pigment distribution, i.e. an irregular pigmentation characterized by areas of faint hyper- or hypopigmentation, without a really patchy aspect as in the multifocal type. ×20. b Asymmetric pigment distribution in a small MIS consisting of 2 parts with the same extension and with a different intensity of pigmentation. ×50.

Clinical and histological data, i.e. the patient’s age and gender, location of the lesion, history of a previous MM and the association with a naevus, were collected in an .xls file.

goto top of outline Statistics

Statistical evaluation was carried out employing the SPSS statistical package (release 12.0.0, 2003; SPSS Inc., Chicago, Ill., USA). The study sample was subdivided into 8 groups, corresponding to the main dermoscopic patterns. Absolute and relative frequencies of each evaluated network descriptor were calculated for each group. Statistical data are presented as mean ± SD.

For the comparison between groups we used the Student t test. For the comparison of proportions referring to the different subtypes of MIS we used the χ2 test of independence (Fisher’s exact test was applied if any expected cell value in the 2 × 2 table <5). All given p values are two-tailed and p < 0.05 indicates statistical significance. Interobserver reproducibility was assessed by means of the ĸ statistics.

 

goto top of outline Results

Patients with MIS had a mean age of 56.5 ± 15.8 years, 53.5% of whom were male. A previous MM had been observed in 12.3% of these patients. Fifty-one percent of lesions were located on the trunk, and had a mean diameter of 10 ± 5.7 mm. In 30.7% of these, histology showed an association with a naevus. Table 2 illustrates the overall dermoscopic aspects of the 114 MIS. As regards pigment distribution, 36% showed a multifocal aspect with areas of hyper- and hypopigmentation, whereas 29.8% showed a uniform pigment distribution. Among descriptors of the 7-point checklist, regression was the most frequent, being observable in 78.1% of the cases. An atypical network was found in 73.7% of the lesions, whereas no MIS showed a veil, traditionally defined as a white ‘ground glass’ film overlying an irregular structureless elevated area of confluent greyish-to-bluish diffuse pigmentation [2]. Regression structures consisted mainly in grey-blue areas, which were observable in 72.8% of the cases; peppering was present in 29.8% and white areas in 10.5% of MIS. Mean scores for asymmetry, borders, colours and dermoscopic structures were 1.4, 1.7, 3.1 and 3.5, respectively, whereas the mean value of the total dermoscopy score was less than that characterizing MM (5.4 ± 1.2), and the 7-point score result was greater than the MM threshold (3.5 ± 1.5).

TAB02
Table 2. Overall dermoscopic aspects of 114 in situ melanomas

The distribution of MIS into different dermoscopic subgroups and the 7-point checklist descriptors are shown in table 3. The most numerous group was represented by reticular grey-blue MIS with areas of regression, followed by the reticular pattern and the multicomponent pattern, whose frequencies are greater than 20%. 10.5% of MIS showed a dermoscopic island, 7% had a spitzoid aspect (including 2 starburst lesions and 6 reticular ones), 6.1% showed an inverse network, 5.3% were composed of grey-blue globules surrounded by the network and only 3 lesions showed mainly light brown globules.

TAB03
Table 3. Distribution of 114 in situ melanomas according to dermoscopic subgroups and 7-point descriptors

An atypical network was found in 100% of reticular and reticular grey-blue lesions, but in only 39.1% of multicomponent ones. We were unable to detect the presence of a veil in any MIS. Atypical vessels were observed in one third of reticular grey-blue and net-grey-blue globule lesions; in contrast, they were never found in reticular, spitzoid and globular MIS. Island lesions were characterized by irregular pigmentation in 41.7% of the cases, more often than other MIS. Irregular dots/globules were observed in 12.5, 19.4 and 2.5% of reticular, reticular grey-blue and spitzoid MIS, respectively. Finally, irregular streaks were mainly found in spitzoid lesions (87.5%), whereas regression was observable in more than 60% of MIS of all categories except lesions characterized by an island or globular pattern. Seven-point scores were diagnostic of MMs in all MIS types except inverse network and globular lesions.

Interobserver agreement about descriptors was good, with ĸ values ranging from 0.5 to 0.7.

Table 4 shows demographic and clinical data and percentage origin from a naevus according to the dermoscopic subgroup. The mean age of the patients was 56.5 years, but in island, spitzoid, net-grey-blue globules and globular lesions the mean age was under 50. Fifty-one percent of MMs were localized on the trunk; however, reticular grey-blue, spitzoid, inverse network and globular lesions were located on the limbs in 74.2, 62.5, 57.1 and 76.7% of the cases, respectively.

TAB04
Table 4. Histological and clinical data of 114 in situ melanomas according to dermoscopic subgroup

Men most frequently showed reticular grey-blue, multicomponent and inverse network aspects, whereas in women reticular, spitzoid, net-grey-blue globules and globular MIS prevailed. However, only the frequency of the multicomponent pattern was significantly higher in men than in women. Also the diameter of the lesions varied according to the dermoscopic pattern. The mean diameter was less than 10 mm in reticular, island, spitzoid and globular lesions, whereas multicomponent and net-grey-blue globular lesions were the largest. Considering the ex naevo origin, island lesions were more frequently associated with a naevus (66.7%); in multicomponent and net-grey-blue globule MIS, the naevus was found in 47.8 and 42.9% of the cases, respectively, whereas in reticular grey-blue and spitzoid lesions the neavus was rarely detected (9.7 and 12.5%, respectively) (fig. 3). Finally, patients reporting a previous MM more frequently (21.7%) were characterized by a multicomponent MIS.

FIG03
Fig. 3. Frequency of the dermoscopic patterns observed in MIS ex naevo vs. MIS de novo. a–c Most MIS with a reticular pattern (70.8%), reticular grey-blue pattern (90.3%) and spitzoid pattern (87.5%) arise on normal skin (de novo). d, e On the other hand, 66.7% of lesions with anisland pattern and 47.8% of multicomponent lesions had an ex naevo origin.

 

goto top of outline Discussion

The complexity of MM diagnosis increases with the reduction in thickness [5]. In the study by Pizzichetta et al. [3], 43% of difficult-to-diagnose MMs were in situ lesions.

In fact, during the growing process an MM shows changing features and develops specific dermoscopic descriptors related to loss of normal growth controls, thus becoming easy to diagnose. On the contrary, the identification of an initial MM can prove difficult because the lesion may not have sufficiently developed atypical clinical and dermoscopic features enabling its diagnosis; it therefore looks very similar to some dermoscopically atypical naevi [18,19].

The dermoscopic aspects of MIS have seldom been the object of dedicated studies [3]. An irregular pigment network is found in most MIS, whereas it is observed in a minority of invasive tumours [20,21].

Radial streaming, atypical vessels, irregular globules and white scar-like areas were detected in 6, 18, 47 and 41%, respectively, of in situ lesions, by Stante et al. [20]. Conversely, in the study by Pizzichetta et al. [3], white scar-like areas were never observed. The same authors found a higher frequency of irregular pigment network, hypopigmentation and brown globules in MIS (especially larger than 10 mm) compared to invasive MMs, where, on the contrary, the blue-whitish veil was more frequently detected.

Semiquantitative algorithms may be of little help in the diagnosis of some MIS. Carli et al. [22] observed that the mean total dermoscopic score for MIS was less than the diagnostic threshold for MMs. Evaluating 50 MIS by the 7-point checklist in a prospective study, Haenssle et al. [21] observed that 22% of the lesions scored 1 point and 14% 4 points, thus concluding that a trend towards a lower 7-point checklist score for MIS makes the differentiation from atypical naevi difficult going solely by the 7-point checklist.

What should we look for at a dermoscopic level in order to identify MMs at a very early stage? The best information is to be had by the description of patterns of lesions finally excised and then diagnosed as MIS after a follow-up period. Assuming that these lesions were already MMs at the first examination, their baseline characteristics were unrecognized by observers finally assessing a change at follow-up. Obviously these lesions lacked specific MM features when examined at first, and their images are suitable for the study of possible new descriptors.

In a follow-up study of 103 early MMs, including 49 MIS, Argenziano et al. [4] noted that at baseline consultation the reticular pattern was the most common global dermoscopy feature observed in 62.1% of the lesions, followed by the unspecific (15.5%) and the multicomponent pattern (9.7%). An asymmetric distribution of colour and structure was noted in 68.6% of the lesions. Regression was seen in 35.9% and was the most prevalent local MM-specific criterion. However, baseline dermoscopic images of 94.2% of the lesions had a total 7-point score within the benign range.

We have recently described some dermoscopic aspects peculiar for MIS and initial MMs, such as reticular grey-blue areas, the dermoscopic island and atypical aspects of the network [11,12]. We identified the reticular pattern of grey-blue regression as a significant discriminator and a reliable predictor of MIS [11]. Moreover, we showed that the dermoscopic island, a well-circumscribed lesion area showing a uniform dermoscopic pattern which differs from the one present in the rest of the lesion, is characteristic of thin MMs, especially in situ ones, arising on a naevus [12].

On reviewing our files on MMs diagnosed as in situ by histology, we observed that the main dermoscopic patterns of MIS may span from those characterized by a network with or without regression features to completely different lesions, including dermoscopic structures other than the network, variously associated and arranged in the lesion.

When globally considering the 114 MIS described in this study we can see that they consist of lesions 1 cm in diameter, equally distributed in men and women and equally located on the trunk and on the limbs. Three quarters of the lesions show an atypical network and regression aspects, whereas atypical vessels, irregular pigmentation and irregular streaks are observed in approximately one quarter of the cases. This overall description proves very inaccurate when considering the different dermoscopic subtypes of MIS, which greatly differ from one another from a dermoscopic point of view and also show different clinical and histological characteristics.

From a practical point of view, the identification of an MM when it is still in situ may be especially difficult in patients with multiple atypical naevi. In these cases, baseline dermoscopic criteria have to be integrated with clinical data and dermoscopic follow-up.

Approximately one third of the MIS presented in this study belonged to the reticular grey-blue group. In these lesions an associated naevus was found in a minority of cases, and this may be due to the regression process involving the associated naevus or rather may indicate that this type of MIS arises de novo. In our series, reticular grey-blue MIS were found on the lower limbs in three quarters of the cases, in subjects with a mean age of 65 years. Lesions showing an atypical network are strictly correlated to those of the former group from a dermoscopic point of view; in fact in some lesions the classic network and reticular grey-blue areas coexist. However, reticular lesions were smaller and located both on the trunk and on the limbs of female patients, 10 years younger than the subjects belonging to the previous group. These lesions look very similar to those described by Carrera et al. [23] in a study considering thin and small MMs on the limbs occurring in high-risk patients attending a referral unit for MMs and pigmented lesions. These authors identified a subset of MMs, comprising 20 lesions, with a prominent or delicate network. As in our series, most of these reticular lesions were in situ and were located on the lower limbs of female patients.

MIS with a spitzoid pattern also arose on a naevus in a low percentage of cases. These were small and located mainly on the limbs of younger women. Therefore, according to our data, an initial MM with a horizontal growth pattern is more likely to present a reticular pattern, possibly associated with regression features or a spitzoid pattern.

On the other hand, island, multicomponent and inverse network MIS show an associated naevus in 66.7, 47.8 and 42.9% of the cases, respectively, and may represent frequent initial patterns of an MIS arising on a naevus. This observation confirms previous findings identifying the dermoscopic island as a marker of thin MMs arising on a naevus [12]. In fact, the presence of a lesion area with a dermoscopic pattern differing from the rest of the lesion could indicate a defect occurring in a benign neoplasm transforming a subclone of cells into a malignant tumour. This should be manifested by the non-uniform growth and appearance of separate patterns present in the same lesion at the same time. At the onset of malignancy, island MIS show network atypia, globules or dots and irregular pigmentation only in one part of their surface. Island MIS are small lesions located on the trunk of male and female patients.

In our multicomponent MIS arising on a naevus of the trunk, a congenital naevus was reported in two thirds of the cases. This may indicate that a multicomponent MIS corresponds to the beginning of an atypical growth in a congenital naevus. This is also suggested by the large size of the lesions belonging to this group. In this case, the MIS maintains the dermoscopic characteristics of the original naevus, showing only small portions of dermoscopic atypia, mainly irregular dots/globules and grey-blue regression.

Finally, among MIS frequently arising on a naevus, those with an inverse network are dermoscopically characterized by irregular dots/globules and regression features, and in some cases atypical vessels, and are 1 cm large, usually found in 50-year-old men and distributed mainly on the limbs.

Recently, evidence has been provided that MM comprises a family of different tumours that vary biologically in growth activity [24,25,26]. Rapidly growing MMs, whose characteristics and associations were described by Liu et al. [24], were more often symmetrical, elevated, amelanotic, symptomatic and with regular borders. In contrast, the study by Argenziano et al. [4], based on a series of MMs that were excised after prolonged follow-up, provided evidence favouring the existence of a type of slow-growing MM, dermoscopically characterized by asymmetric pigmentation and overall reticular pattern. Several intermediate types of MMs may exist varying in their tendency to grow and metastasize, possibly corresponding to different dermoscopic aspects.

To conclude, when employing dermoscopy with the aim of identifying lesions at an early stage of their malignant growth, dermatologists should be aware that initial MMs with horizontal expansion may present with different dermoscopic aspects. We have identified 8 patterns so far, but perhaps, increasing our samples, other patterns will be recognized. These different dermoscopic patterns correspond to different clinical characteristics, i.e. different age and gender distribution and location, to a different origin (ex naevo vs. de novo), and possibly to a different biological potential and a different capacity to grow and metastasize.

 

goto top of outline Disclosure Statement

The authors received no funding and report no conflict of interest.


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  26. Argenziano G, Zalaudek I, Ferrara G: Fast-growing and slow-growing melanomas. Arch Dermatol 2007;143:802–803.

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 goto top of outline Author Contacts

Stefania Seidenari, MD
Department of Dermatology and Venereology
University of Modena and Reggio Emilia, Policlinico di Modena
Via del Pozzo 71, IT–41124 Modena (Italy)
Tel. +39 059 422 4264, E-Mail seidenari.stefania@unimore.it


 goto top of outline Article Information

Received: January 13, 2012
Accepted after revision: March 13, 2012
Published online: May 25, 2012
Number of Print Pages : 9
Number of Figures : 3, Number of Tables : 4, Number of References : 26


 goto top of outline Publication Details

Dermatology

Vol. 224, No. 3, Year 2012 (Cover Date: July 2012)

Journal Editor: Saurat J.-H. (Geneva)
ISSN: 1018-8665 (Print), eISSN: 1421-9832 (Online)

For additional information: http://www.karger.com/DRM


Copyright / Drug Dosage / Disclaimer

Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher or, in the case of photocopying, direct payment of a specified fee to the Copyright Clearance Center.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in goverment regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.

Abstract

Background: Melanomas in situ (MIS) are difficult to diagnose, lacking well-established dermoscopic descriptors. Objective: The aim of this study was to improve the identification of early melanomas describing the variegated dermoscopic features of MIS and their correlation with demographic and clinical aspects. Methods: Dermoscopic images of 114 histologically proven MIS were evaluated by 3 expert dermoscopists and classified into their main dermoscopic patterns. Dermoscopic features were also considered for their correlation with clinical parameters. Results: Eight different dermoscopic subtypes of MIS were identified: reticular grey-blue (27.2%), reticular (21.1%), multicomponent (20.2%), island (10.5%), spitzoid (7%), inverse network (6.1%), ‘net-blue globules’ (5.3%) and globular (2.6%). Clinical characteristics of lesions and patients varied according to the different dermoscopic groups. Conclusion: We hypothesize that the different dermoscopic subgroups of MIS correspond to lesions with a different origin and, possibly, various patterns of growth and a different biological behaviour.



 goto top of outline Author Contacts

Stefania Seidenari, MD
Department of Dermatology and Venereology
University of Modena and Reggio Emilia, Policlinico di Modena
Via del Pozzo 71, IT–41124 Modena (Italy)
Tel. +39 059 422 4264, E-Mail seidenari.stefania@unimore.it


 goto top of outline Article Information

Received: January 13, 2012
Accepted after revision: March 13, 2012
Published online: May 25, 2012
Number of Print Pages : 9
Number of Figures : 3, Number of Tables : 4, Number of References : 26


 goto top of outline Publication Details

Dermatology

Vol. 224, No. 3, Year 2012 (Cover Date: July 2012)

Journal Editor: Saurat J.-H. (Geneva)
ISSN: 1018-8665 (Print), eISSN: 1421-9832 (Online)

For additional information: http://www.karger.com/DRM


Copyright / Drug Dosage

Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher or, in the case of photocopying, direct payment of a specified fee to the Copyright Clearance Center.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in goverment regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.

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    External Resources