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Characteristic Epiluminescent Microscopic Features of Early Malignant Melanoma on Glabrous Skin a Videomicroscopic Analysis

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Characteristic Epiluminescent Microscopic Features of Early Malignant Melanoma on Glabrous Skin a Videomicroscopic Analysis STUDY Characteristic Epiluminescent Microscopic Features of Early Malignant Melanoma on Glabrous Skin A Videomicroscopic Analysis Shinji Oguchi, MD; Toshiaki Saida, MD, PhD; Yoko Koganehira, MD; Sachiko Ohkubo, MD; Yasushi Ishihara, MD; Shigeo Kawachi, MD, PhD Objective: To investigate the characteristic epilumi- Results: On epiluminescent microscopy, malignant mela- nescent microscopic features of early lesions of malig- noma in situ and the macular portions of invasive malig- nant melanoma affecting glabrous skin, which is the most nant melanoma showed accentuated pigmentation on the prevalent site of the neoplasm in nonwhite populations. ridges of the skin markings, which are arranged in par- allel patterns on glabrous skin. This “parallel ridge pattern” Design: The epiluminescent microscopic features of vari- was found in 5 (83%) of 6 lesions of malignant melanoma ous kinds of melanocytic lesions affecting glabrous skin in situ and in 15 (94%) of 16 lesions of malignant melanoma. were investigated using a videomicroscope. All the di- The parallel ridge pattern was rarely found in the lesions agnoses were determined clinically and histopathologi- of benign melanocytic nevus. Most benign melanocytic nevi cally using the standard criteria. showed 1 of the following 3 typical epiluminescent patterns: (1) a parallel furrow pattern exhibiting pigmentation on the Setting: A dermatology clinic at a university hospital. parallel sulci of the skin markings (54%), (2) a latticelike pattern (21%), and (3) a fibrillar pattern showing filamen- Patients: The following 130 melanocytic lesions con- tous or meshlike pigmentation (15%). The remaining 11 secutively diagnosed at our department were examined: benign nevi (10%) showed a nontypical pattern. 16 lesions of acral lentiginous melanoma, 6 lesions of ma- lignant melanoma in situ, and 108 lesions of benign me- Conclusion: Because epiluminescent microscopic fea- lanocytic nevus (acquired or congenital). tures of early malignant melanoma on glabrous skin are characteristic, we can effectively detect early lesions us- Main Outcome Measure: The incidence of each char- ing this noninvasive method. acteristic epiluminescent feature was compared among disease categories. Arch Dermatol. 1998;134:563-568 PILUMINESCENT micros- lignant melanoma on glabrous skin, copy, also called dermatos- comparing them with those of benign me- copy or surface micros- lanocytic nevi on these sites. copy, is now widely used for the clinical evaluation of RESULTS Epigmented skin lesions.1-11 The most im- portant use of this technique is in the ac- MALIGNANT MELANOMA IN SITU curate diagnosis of malignant melanoma, particularly in its early stages. Although The clinical data of 6 patients with malig- many investigators have reported valu- nant melanoma in situ are shown in able findings on the subject, most au- Table 2. The main epiluminescent mi- thors investigated pigmented lesions of croscopic features of malignant mela- nonglabrous skin. In a previous study of noma in situ are summarized in Table 3. the use of a videomicroscope,12 the macu- All the lesions showed an abrupt edge, From the Department of lar and plaque portions of acral lentigi- namely, a sharply cut-off margin of pig- Dermatology, Shinshu nous melanoma of glabrous skin exhib- mentation, at least in a portion. Five of the University School of Medicine, ited accentuated pigmentation of the ridges 6 lesions showed accentuated pigmenta- Matsumoto (Drs Oguchi, Saida, Koganehira, Ohkubo, and of the skin markings that run mostly in tion on the ridges of the skin markings that Kawachi), and the Division of parallel on these anatomical sites. In this run mostly in a parallel pattern on the ana- Dermatology, Hokushin study, also with the use of a videomicro- tomical sites (Figure 1). In contrast, the General Hospital, Nakano scope, we investigated epiluminescent mi- furrows of the skin markings were com- (Dr Ishihara), Nagano, Japan. croscopic features of early lesions of ma- paratively devoid of pigmentation. This ARCH DERMATOL / VOL 134, MAY 1998 563 ©1998 American Medical Association. All rights reserved. Downloaded From: https://jamanetwork.com/ on 09/30/2021 Table 1. Melanocytic Lesions on Glabrous Skin MATERIALS AND METHODS Investigated With Videomicroscopy Diagnosis No. of Lesions A total of 130 pigmented lesions on glabrous skin, Benign melanocytic nevus 108* including 6 lesions of malignant melanoma in situ, Junctional type 80† 16 of acral lentiginous melanoma, and 108 of ac- Compound type 28 quired or congenital melanocytic nevus, were inves- Intradermal type 0 tigated using a videomicroscope. All the lesions were Acral lentiginous melanoma 16 seen in Japanese patients at the Department of Der- Malignant melanoma in situ 6 matology, Shinshu University Hospital, Matsu- Total 130 moto, Japan, from November 5, 1990, to June 30, 1996 (Table 1). Informed consent was obtained from all *Ten lesions were diagnosed as congenital nevus. patients. The diagnoses were all determined clini- †Seven lesions of lentigo simplex were included. cally and histopathologically based on the standard criteria. Lentigo simplex was classified as acquired melanocytic nevus. Most of the melanocytic nevi were Table 2. Clinical Data of Patients from the foot, as follows: 72 lesions on the sole or With Malignant Melanoma In Situ of the Sole volar aspect of the toes and 36 lesions on the palm or volar aspect of the fingers. All the lesions of ma- Patient No./Sex/Age, y Size of Lesion, mm lignant melanoma and malignant melanoma in situ were from the sole of the foot. 1/F/75 16.0 3 4.0 As described in detail in a previous report,12 each 2/F/27 15.0 3 4.0 3/F/46 11.5 3.5 lesional site was immersed with mineral oil and cov- 3 4/M/54 6.0 3 5.0 ered with a glass slide. With the camera probe ap- 5/M/67 16.0 3 11.0 plied to the slide, the magnified features, 320, 350, 6/F/73 22.0 3 11.0 and 3100, were viewed on a color monitor of the vid- eomicroscope and recorded on a video floppy disk. Table 3. Incidence of Videomicroscopic Features pigmentation pattern was observed in large areas of all of Melanocytic Lesions on Glabrous Skin (N = 130) cases. We designated this feature as a “parallel ridge pat- tern.” Corresponding to this epiluminescent finding, his- Melanocytic Lesions, No. (%) topathological examination revealed that a proliferation Acral Malignant Benign of atypical melanocytes with melanin granules was promi- Lentiginous Melanoma Melanocytic nent on the crista profunda intermedia, ie, epidermal rete Melanoma* In Situ Nevus ridges beneath the surface ridges and passed through by Features (n = 16) (n=6) (n = 108) an intraepidermal eccrine duct. Diffuse multicompo- Parallel ridge pattern 15 (94) 5 (83) 0 nent pigmentation composed of pigmented blotches of Abrupt edge 12 (75) 6 (100) 0 Peripheral dots 10 (62) 4 (67) 0 variegated shades of brown was observed in portions of Diffuse multicomponent 3 lesions. Peripheral black dots of various sizes were de- pigmentation 12 (75) 3 (50) 3 (3) tected in 4 lesions, which corresponded histopathologi- Fibrillar pattern 7 (44)† 1 (17) 16 (15) cally to the aggregated melanin granules shed into the Parallel furrow or cornified layer of the epidermis. One lesion of mela- latticelike pattern 4 (25)† 0 81 (75) noma in situ (patient 2 in Table 2) did not show the par- *Findings detected in the macular portions. allel ridge pattern but exhibited the fibrillar pattern of †Detected only in small areas within the lesions. subtype A (Figure 2), one observed in some lesions of melanocytic nevus as described later. In this lesion, de- pigmentation was observed on the periphery, resulting Table 3. The epiluminescent findings of the macular por- in an irregular, asymmetric configuration of the lesion. tions were essentially identical to those observed in the Pseudopods were rarely found in the lesions of mela- malignant melanoma in situ lesions. The parallel ridge noma in situ on the sole. Furthermore, the parallel fur- pattern was a predominant feature of 15 (94%) of the 16 row and latticelike patterns, which were the most com- lesions. The diffuse multicomponent pigmentation was mon patterns in benign nevi, were not detected in any found in 12 lesions of malignant melanoma (75%) at least lesions of melanoma in situ. in some portions within the lesions. The abrupt edge (75%) and peripheral dots (62%) were also frequently MALIGNANT MELANOMA detected. In the invasive portions of malignant mela- noma, blotches of varying shades of brown, randomly dis- The 16 invasive primary lesions of acral lentiginous mela- tributed black dots or brown globules, the blue-gray veil noma ranged from 15 to 75 mm in maximum diameter (ie, diffuse bluish-gray pigmentation with a somewhat and from 1.0 to 8.0 mm in Breslow tumor thickness whitish hue), and depigmented areas were frequently rec- (Table 4). The epiluminescent microscopic features of ognized. The fibrillar pattern was detected in some small the macular portions of the lesions are summarized in areas of 7 (44%) of the 16 lesions. The parallel furrow ARCH DERMATOL / VOL 134, MAY 1998 564 ©1998 American Medical Association. All rights reserved. Downloaded From: https://jamanetwork.com/ on 09/30/2021 A A B B C C Figure 1. Clinical (A), videomicroscopic (B, magnification 3100), and Figure 2. Clinical (A), videomicroscopic (B, magnification 350), and histopathological (C, magnification 375) features of malignant melanoma in histopathological features (C, magnification 3150) of malignant melanoma situ of the sole of the foot. The characteristic parallel ridge pattern exhibiting in situ. The fibrillar pattern of subtype A is clearly observed with selective pigmentation of the ridges of the skin markings is clearly videomicroscopy. demonstrated with videomicroscopy. and the latticelike patterns were rare in the lesions of ma- the lesions showed solitary arranged melanocytes in the lignant melanoma, detected only in small portions in 4 lower epidermis. of the 16 lesions.
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