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J EUR ACAD DERMATOL: dermatoscope and confocal prediction to diagnose malignant freckle-like moles
▎ Clinical problems:
malignant freckle-like moles and malignant freckle-like moles (AHLM/LMM) are difficult to diagnose in the early stage. Currently, the predictive diagnostic value of AHLM/LMM features acquired using dermatoscopes and reflective confocal microscopy (RCM) is unclear.
A study from J EUR ACAD DERMATO shows that dermatoscope features of AHLM/LMM can be identified.
▎ Study Protocol:
The patient has AHLM/LMM, pigmented or hypopigmented benign lesions (AHBL), pigmented or hypopigmented basal and squamous cell carcinoma (AHBCC/AHSCC) in the head or neck, and was diagnosed by dermatoscope and RCM imaging. This study continuously collected patient data retrospectively and was blindly evaluated by three researchers to analyze whether they were in compliance with dermatoscope and RCM-related indicators. A total of 224 lesions in 216 patients were analyzed in this study, including LM/LMM (n=55, 24.6%), AHBL (n=107, 47.8%), and AHBCC/AHSCC (n=62, 27.7%).
▎ main discovery:
1. Multivariable analysis showed that compared with AHBL, the following characteristics were obviously independent factors for the diagnosis of AHLM/LMM: the milky red area in the dermatoscopy (OR=5.46; 95%CI, 1.51-19.75), the peripheral hazel-free structured area (OR=19.10; 95%CI, 4.45-81.96), and irregularly distributed linear blood vessels (OR=5.44; 95%CI, 1.45- 20.40) and asymmetric pigment reticulum (OR=14.45; 95%CI, 2.77-75.44), there were ≥3 atypical cells in the 5 fields of view in RCM (OR=10.12; 95%CI, 3.00-34.12) and focal follicle localization of atypical cells at the dermal epidermal junction (DEJ) (OR=10.48; 95%CI, 1.10-99.81).
2. Compared with AHBCC/AHSCC, the following characteristics are obviously independent factors for the diagnosis of AHLM/LMM: peripheral hazel-free structured regions in the dermatoscope (OR=7.11; 95%CI, 1.53-32.96), hair follicle basal pseudo-reticular erythema (OR=16.69; 95%CI, 2.73-102.07), and ring-grained structures (OR=42.36; 95%CI, 3.51-511.16), large dendritic cells in RCM (OR=6.86; 95%CI, 3.1-to-38.28), and circular pagetoid cells (OR=26.78; 95%CI, 3.15-227.98).
▎ Outlook:
AHLM/LMM may have the same dermatoscopic features as AHM in other areas, such as milky red areas, peripheral hazel-free structured areas and irregularly distributed linear blood vessels. Even if the traditional optical microscopic features are not possessed (such as hair follicle occlusion under dermatoscopy and large pagetoid cells under RCM), or if the above features appear only in a very small number of lesions, the following features can be used to identify AHLM/LMM: asymmetric pigment reticulum, ≥3 atypical cells in the 5 visual fields under RCM, and focal follicle localization of atypical cells at DEJ.
References:
[1]
https://onlinelibrary.wiley.com/doi/10.1111/jdv.18636
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This article is first published: Medical World Tumor Channel
Author: Dingchao Jingyao Group
Editor: Sweet
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