Pigmented skin lesions displaying regression features: Dermoscopy and reflectance confocal microscopy criteria for diagnosis

Elvira Moscarella, Caterina Bombonato, Riccardo Pampena, Athanassios Kyrgidis, Elisa Benati, Simonetta Piana, Stefania Borsari, Aimilios Lallas, Giovanni Pellacani, Giuseppe Argenziano, Caterina Longo

Research output: Contribution to journalArticle

Abstract

Melanomas and nevi displaying regression features can be difficult to differentiate. To describe reflectance confocal microscopy features in benign and malignant pigmented skin lesions characterized by regression features in dermoscopy. Observational retrospective study. Inclusion criteria were presence of dermoscopic features of regression; availability of clinical, dermoscopic and RCM imaging; definite histopathologic diagnosis. The study sample comprised 217 lesions; 108 (49.8%) melanomas and 109 were benign lesions, of which 102 (47.0%) nevi and 7 (3.2%) lichen planus-like keratosis (lplk). Patients with melanoma were significantly older than those with benign lesions (61.9 ± 15.4 vs 46.1 ± 14.8; P < 0.001) and a higher proportion of melanomas displayed dermoscopic regression structures in more than 50% of lesion surface (n = 83/108; 76.9%; P < 0.001). On RCM examination, pagetoid cells were significantly more reported in melanoma group, than in benign lesions (86.1% vs 59.6%; P < 0.001) and were more frequently widespread distributed (65.6% vs 20.0%; P < 0.001) and both dendritic and roundish (36.6% vs 15.4%; P < 0.001) in shape. Aspecific architecture at the dermo-epidermal junction (DEJ) was more commonly seen among melanomas than benign lesions (23.1% vs 11.9%; P = 0.002) with higher presence of dendritic and both dendritic and roundish atypical cells at the DEJ (28.7% vs 18.3% and 19.4% vs 3.7%; P < 0.001, respectively). Focal pagetoid infiltration and ringed or clod patterns were more commonly seen in benign lesion. In conclusion, the correct interpretation of regressing lesions remains a challenge, assessing carefully the extent and characteristics of architectural and cytologic atypia on RCM is an additional piece of the complex puzzle of melanoma diagnosis.

Original languageEnglish
JournalExperimental Dermatology
DOIs
Publication statusE-pub ahead of print - Dec 2 2018

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Dermoscopy
Confocal microscopy
Confocal Microscopy
Melanoma
Skin
Infiltration
Availability
Imaging techniques
Nevi and Melanomas
Keratosis
Lichen Planus
Nevus
Observational Studies
Retrospective Studies
Lichens

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Pigmented skin lesions displaying regression features : Dermoscopy and reflectance confocal microscopy criteria for diagnosis. / Moscarella, Elvira; Bombonato, Caterina; Pampena, Riccardo; Kyrgidis, Athanassios; Benati, Elisa; Piana, Simonetta; Borsari, Stefania; Lallas, Aimilios; Pellacani, Giovanni; Argenziano, Giuseppe; Longo, Caterina.

In: Experimental Dermatology, 02.12.2018.

Research output: Contribution to journalArticle

Moscarella, Elvira ; Bombonato, Caterina ; Pampena, Riccardo ; Kyrgidis, Athanassios ; Benati, Elisa ; Piana, Simonetta ; Borsari, Stefania ; Lallas, Aimilios ; Pellacani, Giovanni ; Argenziano, Giuseppe ; Longo, Caterina. / Pigmented skin lesions displaying regression features : Dermoscopy and reflectance confocal microscopy criteria for diagnosis. In: Experimental Dermatology. 2018.
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abstract = "Melanomas and nevi displaying regression features can be difficult to differentiate. To describe reflectance confocal microscopy features in benign and malignant pigmented skin lesions characterized by regression features in dermoscopy. Observational retrospective study. Inclusion criteria were presence of dermoscopic features of regression; availability of clinical, dermoscopic and RCM imaging; definite histopathologic diagnosis. The study sample comprised 217 lesions; 108 (49.8{\%}) melanomas and 109 were benign lesions, of which 102 (47.0{\%}) nevi and 7 (3.2{\%}) lichen planus-like keratosis (lplk). Patients with melanoma were significantly older than those with benign lesions (61.9 ± 15.4 vs 46.1 ± 14.8; P < 0.001) and a higher proportion of melanomas displayed dermoscopic regression structures in more than 50{\%} of lesion surface (n = 83/108; 76.9{\%}; P < 0.001). On RCM examination, pagetoid cells were significantly more reported in melanoma group, than in benign lesions (86.1{\%} vs 59.6{\%}; P < 0.001) and were more frequently widespread distributed (65.6{\%} vs 20.0{\%}; P < 0.001) and both dendritic and roundish (36.6{\%} vs 15.4{\%}; P < 0.001) in shape. Aspecific architecture at the dermo-epidermal junction (DEJ) was more commonly seen among melanomas than benign lesions (23.1{\%} vs 11.9{\%}; P = 0.002) with higher presence of dendritic and both dendritic and roundish atypical cells at the DEJ (28.7{\%} vs 18.3{\%} and 19.4{\%} vs 3.7{\%}; P < 0.001, respectively). Focal pagetoid infiltration and ringed or clod patterns were more commonly seen in benign lesion. In conclusion, the correct interpretation of regressing lesions remains a challenge, assessing carefully the extent and characteristics of architectural and cytologic atypia on RCM is an additional piece of the complex puzzle of melanoma diagnosis.",
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T2 - Dermoscopy and reflectance confocal microscopy criteria for diagnosis

AU - Moscarella, Elvira

AU - Bombonato, Caterina

AU - Pampena, Riccardo

AU - Kyrgidis, Athanassios

AU - Benati, Elisa

AU - Piana, Simonetta

AU - Borsari, Stefania

AU - Lallas, Aimilios

AU - Pellacani, Giovanni

AU - Argenziano, Giuseppe

AU - Longo, Caterina

N1 - © 2018 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

PY - 2018/12/2

Y1 - 2018/12/2

N2 - Melanomas and nevi displaying regression features can be difficult to differentiate. To describe reflectance confocal microscopy features in benign and malignant pigmented skin lesions characterized by regression features in dermoscopy. Observational retrospective study. Inclusion criteria were presence of dermoscopic features of regression; availability of clinical, dermoscopic and RCM imaging; definite histopathologic diagnosis. The study sample comprised 217 lesions; 108 (49.8%) melanomas and 109 were benign lesions, of which 102 (47.0%) nevi and 7 (3.2%) lichen planus-like keratosis (lplk). Patients with melanoma were significantly older than those with benign lesions (61.9 ± 15.4 vs 46.1 ± 14.8; P < 0.001) and a higher proportion of melanomas displayed dermoscopic regression structures in more than 50% of lesion surface (n = 83/108; 76.9%; P < 0.001). On RCM examination, pagetoid cells were significantly more reported in melanoma group, than in benign lesions (86.1% vs 59.6%; P < 0.001) and were more frequently widespread distributed (65.6% vs 20.0%; P < 0.001) and both dendritic and roundish (36.6% vs 15.4%; P < 0.001) in shape. Aspecific architecture at the dermo-epidermal junction (DEJ) was more commonly seen among melanomas than benign lesions (23.1% vs 11.9%; P = 0.002) with higher presence of dendritic and both dendritic and roundish atypical cells at the DEJ (28.7% vs 18.3% and 19.4% vs 3.7%; P < 0.001, respectively). Focal pagetoid infiltration and ringed or clod patterns were more commonly seen in benign lesion. In conclusion, the correct interpretation of regressing lesions remains a challenge, assessing carefully the extent and characteristics of architectural and cytologic atypia on RCM is an additional piece of the complex puzzle of melanoma diagnosis.

AB - Melanomas and nevi displaying regression features can be difficult to differentiate. To describe reflectance confocal microscopy features in benign and malignant pigmented skin lesions characterized by regression features in dermoscopy. Observational retrospective study. Inclusion criteria were presence of dermoscopic features of regression; availability of clinical, dermoscopic and RCM imaging; definite histopathologic diagnosis. The study sample comprised 217 lesions; 108 (49.8%) melanomas and 109 were benign lesions, of which 102 (47.0%) nevi and 7 (3.2%) lichen planus-like keratosis (lplk). Patients with melanoma were significantly older than those with benign lesions (61.9 ± 15.4 vs 46.1 ± 14.8; P < 0.001) and a higher proportion of melanomas displayed dermoscopic regression structures in more than 50% of lesion surface (n = 83/108; 76.9%; P < 0.001). On RCM examination, pagetoid cells were significantly more reported in melanoma group, than in benign lesions (86.1% vs 59.6%; P < 0.001) and were more frequently widespread distributed (65.6% vs 20.0%; P < 0.001) and both dendritic and roundish (36.6% vs 15.4%; P < 0.001) in shape. Aspecific architecture at the dermo-epidermal junction (DEJ) was more commonly seen among melanomas than benign lesions (23.1% vs 11.9%; P = 0.002) with higher presence of dendritic and both dendritic and roundish atypical cells at the DEJ (28.7% vs 18.3% and 19.4% vs 3.7%; P < 0.001, respectively). Focal pagetoid infiltration and ringed or clod patterns were more commonly seen in benign lesion. In conclusion, the correct interpretation of regressing lesions remains a challenge, assessing carefully the extent and characteristics of architectural and cytologic atypia on RCM is an additional piece of the complex puzzle of melanoma diagnosis.

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DO - 10.1111/exd.13853

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JO - Experimental Dermatology

JF - Experimental Dermatology

SN - 0906-6705

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