Centro Oncologico ad Alta Tecnologia Diagnostica, Azienda Unità Sanitaria Locale - IRCCS di Reggio Emilia, Reggio Emilia, Italy.
Department of Dermatology, University of Rome "Tor Vergata", Rome, Italy.
Int J Dermatol. 2020 Jul;59(7):813-821. doi: 10.1111/ijd.14918. Epub 2020 May 13.
Nevus-associated melanoma (NAM) has been regarded as a distinct biological entity from de-novo melanoma (DNM); however, static dermoscopy often fails in differentiating these entities. Digital dermoscopic monitoring allows to identify dynamic changes occurring during follow-up; this may improve diagnostic accuracy and potentially our knowledge on NAM biology. We aimed to define main independent factors associated with NAM diagnosis and those influencing follow-up time in a population of melanomas excised at follow-up.
A cohort of melanomas excised at follow-up was retrospectively and consecutively selected. NAMs and DNMs were compared according to baseline features and main dermoscopic changes occurring during follow-up. Univariate and multivariable logistic and Cox's regression analysis were performed to respectively define factors associated with NAM diagnosis and those influencing the risk for excision.
Eighty-six melanomas were enrolled, of which 21 (24.4%) were nevus-associated. During follow-up NAMs mainly underwent atypical network modifications (47.6%), followed by inverse network (28.6%) and dermoscopic island (23.8%) worsening or appearance. DNMs were also mainly characterized by atypical network modifications (47.7%), however, a significant proportion of cases underwent irregular pigmentation/dots/globules or regression changes (29.2%), which were rarely seen among NAMs. Furthermore, both multivariable logistic and Cox's regression analysis demonstrated a significant association between NAM and a longer follow-up.
We demonstrated that among melanomas excised at follow-up, different patterns of dermoscopic changes may be found between NAMs and DNMs. This finding, together with the association of NAM with a longer follow-up time, supports the hypothesis of different biological behavior of these two entities.
痣相关黑色素瘤（NAM）已被视为一种与新发黑色素瘤（DNM）不同的生物学实体；然而，静态皮肤镜检查往往无法区分这两种实体。数字皮肤镜监测可以识别随访过程中发生的动态变化；这可能会提高诊断准确性，并有可能提高我们对 NAM 生物学的认识。我们旨在确定与 NAM 诊断相关的主要独立因素，并确定影响随访时间的因素，这些因素在随访时切除的黑色素瘤人群中。
回顾性连续选择了一组在随访时切除的黑色素瘤。根据基线特征和随访过程中主要皮肤镜变化，比较了 NAMs 和 DNMs。分别进行单变量和多变量逻辑和 Cox 回归分析，以确定与 NAM 诊断相关的因素和影响切除风险的因素。
共纳入 86 例黑色素瘤，其中 21 例（24.4%）为痣相关。在随访期间，NAM 主要经历了非典型网络修改（47.6%），其次是反向网络（28.6%）和皮肤镜岛（23.8%）恶化或出现。DNMs 也主要表现为非典型网络修改（47.7%），但相当比例的病例出现不规则色素沉着/点/球或退行性变化（29.2%），这些变化在 NAMs 中很少见。此外，多变量逻辑和 Cox 回归分析均表明 NAM 与随访时间延长之间存在显著关联。
我们证明，在随访时切除的黑色素瘤中，NAM 和 DNM 之间可能存在不同的皮肤镜变化模式。这一发现，加上 NAM 与更长随访时间的关联，支持了这两种实体具有不同生物学行为的假设。
