1st Department of Dermatology-Venereology, Andreas Sygros Hospital, National and Kapodistrian University of Athens School of Medicine, Athens, Greece.
1st Department of Dermatology, Aristotle University, Thessaloniki, Greece.
J Eur Acad Dermatol Venereol. 2020 Nov;34(11):2541-2547. doi: 10.1111/jdv.16815. Epub 2020 Aug 24.
Thin nodular melanoma (NM) often lacks conspicuous melanoma-specific dermatoscopic criteria and escapes clinical detection until it progresses to a thicker and more advanced tumour.
To investigate the dermatoscopic morphology of thin (≤2 mm Breslow thickness) vs. thick (>2 mm) NM and to identify dermatoscopic predictors of its differential diagnosis from other nodular tumours.
Retrospective, morphological case-control study, conducted on behalf of the International Dermoscopy Society. Dermatoscopic images of NM and other nodular tumours from 19 skin cancer centres worldwide were collected and analysed.
Overall, 254 tumours were collected (69 NM of Breslow thickness ≤2 mm, 96 NM >2 mm and 89 non-melanoma nodular lesions). Light brown coloration (50.7%) and irregular brown dots/globules (42.0%) were most frequently observed in ≤2 mm NMs. Multivariate analysis revealed that dotted vessels (3.4-fold), white shiny streaks (2.9-fold) and irregular blue structureless area (2.4-fold) were predictors for thinner NM compared to non-melanoma nodular tumours. Overall, irregular blue structureless area (3.4-fold), dotted vessels (4.6-fold) and serpentine vessels (1.9-fold) were predictors of all NM compared to non-melanoma nodular lesions.
Absence of a centralized, consensus pathology review and cases selected form tertiary centres maybe not reflecting the broader community.
Our study sheds light into the dermatoscopic morphology of thin NM in comparison to thicker NM and could provide useful clues for its differential diagnosis from other non-melanoma nodular tumours.
薄结节性黑素瘤（NM）常缺乏明显的黑素瘤特异性皮肤镜特征，直到发展为更厚、更高级别的肿瘤时才被临床发现。
研究薄（≤2mm Breslow 厚度）与厚（>2mm）NM 的皮肤镜形态，并确定有助于将其与其他结节性肿瘤进行鉴别诊断的皮肤镜预测指标。
本研究为代表国际皮肤镜学会开展的回顾性形态学病例对照研究。从全球 19 个皮肤癌中心收集了 NM 和其他结节性肿瘤的皮肤镜图像并进行了分析。
共收集了 254 个肿瘤（69 个 NM 的 Breslow 厚度≤2mm，96 个 NM >2mm，89 个非黑素瘤结节性病变）。≤2mm NM 中最常观察到淡棕色颜色（50.7%）和不规则棕色点/球（42.0%）。多变量分析显示，点状血管（3.4 倍）、白色闪亮条纹（2.9 倍）和不规则蓝色无结构区（2.4 倍）是 NM 较非黑素瘤结节性肿瘤更薄的预测指标。总的来说，不规则蓝色无结构区（3.4 倍）、点状血管（4.6 倍）和蛇形血管（1.9 倍）是 NM 与非黑素瘤结节性病变的鉴别预测指标。
缺乏集中的共识病理审查，且所选病例来自三级中心，可能无法反映更广泛的社区情况。
本研究阐明了与厚 NM 相比薄 NM 的皮肤镜形态，并为其与其他非黑素瘤结节性肿瘤的鉴别诊断提供了有用线索。
