Dermoscopic features causing confusion between melanoma and benign nevi in clinical diagnosis - case series. 2021

Karolina Englert, and Agata Kłosowicz, and Alicja Lazar, and Anna Wojas-Pelc
Department of Dermatology, Collegium Medicum, Jagiellonian University in Cracow, Poland.

The vast majority of melanoma lesions show typical dermoscopic features such as the presence of atypical pigmented network, the variety of colors within nevi, the asymmetry of structures and the presence of structureless areas. The clinical appearance of melanocytic lesions evolving over time also constitutes a clue to discover their malignant potential. Albeit there are some cases that do not exhibit typical dermoscopic and clinical findings suggesting their malignant potential. METHODS We report 4 cases of melanoma with their equivocal dermoscopic images and ambiguous clinical pictures. We acknowledge dermoscopic features such as: the presence of variform, peripheral globules suggesting the possible growth of the nevus, the presence of terminal hair within the melanoma lesion and we confirm that only on the basis of this criterion we cannot qualify such melanocytic lesions to the benign category. We also report the case of the two-component lesion consisted of reticular-homogenous pattern and concentrated globules in the superior pole of the nevus with no significant signs of evolution during one year period of surveillance and the case of the two-component lesion consisted of reticular - homogenous pattern with focal areas of higher density network and the presence of polymorphous, dotted, coiled, comma-like vessels which met the criterion of the ugly duckling sign. Dermoscopy is the most useful noninvasive diagnostic tool designed to discriminate skin nevi. Despite its benefits, the interpretation of a dermoscopic image is not always unequivocal. Some melanoma lesions exhibit only single features included in the assessment algorithms used in everyday dermatological practice such as: the ABCDE rule, the pattern analysis, the 7-points Glasgow checklist, the Menzies method, the 3-point checklist. The presence and the shape of vessels within nevi also constitute an important diagnostic indicator of melanoma. Dotted vessels are related to early stages of melanoma and polymorphous, elongated, linear, vessels are connected with more advanced stages. Therefore, dermoscopic examination should be performed by trained physicians. In case when predicted biological potential of melanocytic lesions is uncertain the excision of suspected lesions followed by histopathological examination should be carried out.

UI MeSH Term Description Entries
D008545 Melanoma A malignant neoplasm derived from cells that are capable of forming melanin, which may occur in the skin of any part of the body, in the eye, or, rarely, in the mucous membranes of the genitalia, anus, oral cavity, or other sites. It occurs mostly in adults and may originate de novo or from a pigmented nevus or malignant lentigo. Melanomas frequently metastasize widely, and the regional lymph nodes, liver, lungs, and brain are likely to be involved. The incidence of malignant skin melanomas is rising rapidly in all parts of the world. (Stedman, 25th ed; from Rook et al., Textbook of Dermatology, 4th ed, p2445) Malignant Melanoma,Malignant Melanomas,Melanoma, Malignant,Melanomas,Melanomas, Malignant
D009506 Nevus A circumscribed stable malformation of the skin and occasionally of the oral mucosa, which is not due to external causes and therefore presumed to be of hereditary origin. Mole, Skin,Moles, Skin,Skin Mole,Nevi,Skin Moles
D006801 Humans Members of the species Homo sapiens. Homo sapiens,Man (Taxonomy),Human,Man, Modern,Modern Man

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