Pampín-Franco A, Gamo-Villegas R, Floristán-Muruzábal U, Pinedo-Moraleda F J, Pérez-Fernández E, López-Estebaranz J L
Dermatology Unit, University Hospital Fundación Alcorcón, Madrid, Spain.
Pathology Unit, University Hospital Fundación Alcorcón, Madrid, Spain.
J Eur Acad Dermatol Venereol. 2021 May;35(5):1133-1142. doi: 10.1111/jdv.17105. Epub 2021 Feb 4.
The management of melanocytic lesions with peripheral globules (MLPGs) is usually age-dependent and can be challenging in high-risk melanoma patients.
To evaluate clinical, dermoscopic and reflectance confocal microscopy (RCM) features of MLPG in patients under digital dermoscopic surveillance. To know whether dermoscopic or RCM findings correlate with histologic diagnosis and the accuracy of the dermoscopy-RCM compared with histopathology.
During 24 months, we prospectively enrolled MLPG in patients under digital dermoscopy follow-up. All were evaluated by dermoscopy and RCM and excised for histologic examination.
We enrolled 154 patients, mean age 42.45 years (18.78-73.19). Three melanomas and 19 dysplastic naevi (DNs) were diagnosed. There were no significant differences in the age of the patients (P = 0.662). MLPGs with diameter of 6 mm or more and asymmetry in two axes were associated with melanoma (P = 0.01, P = 0.003). Patients with more than one MLPG were less likely to have melanoma. Blue-grey and red colours were more frequent in melanoma (P = 0.013 and P = 0.000). Different sizes and shapes of PG were associated with DN and melanoma (P = 0.000 and P = 0.001). In a new lesion, PG in <25% of the circumference was related to malignancy (P = 0.010). RCM signs of malignancy were related to melanoma: pagetoid cells (P = 0.000), non-edged papillae (P = 0.001), atypical junctional thickenings (P = 0.000) and atypical cells at the dermal-epidermal junction (P = 0.000). Dense irregular nests were associated to melanoma (P = 0.019). Dermoscopy and confocal evaluation were able to diagnose 100% of melanomas and 84.21% of DNs. The kappa coefficient between dermoscopy-RCM vs. histology was 0.76.
We recommend to excise a MLPG when it presents asymmetry in two axes, 6 or more mm, new lesion with PG in less than the 25% of the circumference, irregular size and shape PGs and irregular dense nests on RCM, regardless of the patient's age.
外周小球状黑素细胞性病变（MLPGs）的处理通常取决于年龄，对于高危黑色素瘤患者可能具有挑战性。
评估接受数字皮肤镜监测的患者中MLPGs的临床、皮肤镜和反射式共聚焦显微镜（RCM）特征。了解皮肤镜或RCM检查结果是否与组织学诊断相关，以及皮肤镜-RCM与组织病理学相比的准确性。
在24个月期间，我们前瞻性纳入了接受数字皮肤镜随访的MLPGs患者。所有患者均接受皮肤镜和RCM检查，并切除病变进行组织学检查。
我们纳入了154例患者，平均年龄42.45岁（18.78 - 73.19岁）。诊断出3例黑色素瘤和19例发育异常痣（DNs）。患者年龄无显著差异（P = 0.662）。直径6mm或更大且两轴不对称的MLPGs与黑色素瘤相关（P = 0.01，P = 0.003）。有多个MLPGs的患者患黑色素瘤的可能性较小。蓝灰色和红色在黑色素瘤中更常见（P = 0.013和P = 0.000）。不同大小和形状的小球与DN和黑色素瘤相关（P = 0.000和P = 0.001）。在新病变中，小球占周长小于25%与恶性肿瘤相关（P = 0.010）。RCM的恶性征象与黑色素瘤相关：派杰样细胞（P = 0.000）、无边缘乳头（P = 0.001）、非典型交界性增厚（P = 0.000）和真皮-表皮交界处的非典型细胞（P = 0.000）。密集不规则巢与黑色素瘤相关（P = 0.019）。皮肤镜和共聚焦评估能够诊断100%的黑色素瘤和84.21%的DNs。皮肤镜-RCM与组织学之间的kappa系数为0.76。
我们建议，当MLPGs呈现两轴不对称、直径6mm或更大、新病变中小球占周长小于25%、小球大小和形状不规则以及RCM上有不规则密集巢时，无论患者年龄如何，均应切除。
