Unit of Dermatology and Cosmetology, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy.
La Sapienza University of Rome, 00185 Rome, Italy.
Medicina (Kaunas). 2024 Jul 30;60(8):1239. doi: 10.3390/medicina60081239.
: Amelanotic/hypomelanotic melanomas (AHMs) account for 2-8% of all cutaneous melanomas. Due to their clinical appearance and the lack of specific dermoscopic indicators, AHMs are challenging to diagnose, particularly in thinner cutaneous lesions. The aim of our study was to evaluate the clinicopathological and dermoscopic features of thin AHMs. Identifying the baseline clinical-pathological features and dermoscopic aspects of thin AHMs is crucial to better understand this entity. : We divided the AHM cohort into two groups based on Breslow thickness: thin (≤1.00 mm) and thick (>1.00 mm). This stratification helped identify any significant clinicopathological differences between the groups. For dermoscopic analysis, we employed the "pattern analysis" approach, which involves a simultaneous and subjective assessment of different criteria. : Out of the 2.800 melanomas analyzed for Breslow thickness, 153 were identified as AHMs. Among these, 65 patients presented with thin AHMs and 88 with thick AHMs. Red hair color and phototype II were more prevalent in patients with thin AHMs. The trunk was the most common anatomic site for thin AHMs. Patients with thin AHMs showed a higher number of multiple melanomas. Dermoscopic analysis revealed no significant difference between thin AHMs and thick AHMs, except for a more frequent occurrence of residual reticulum in thin AHMs. : Thin AHMs typically affect individuals with lower phototypes and red hair color. These aspects can be related to the higher presence of pheomelanin, which provides limited protection against sun damage. This also correlates with the fact that the trunk, a site commonly exposed to intermittent sun exposure, is the primary anatomical location for thin AHMs. Multiple primary melanomas are more common in patients with thin AHMs, likely due to an intrinsic predisposition as well as greater periodic dermatologic follow-ups in this class of patients. Apart from the presence of residual reticulum, no other significant dermoscopic differences were observed, complicating the differential diagnosis between thin and thick AHMs based on dermoscopy alone.
无色素性/低色素性黑素瘤（AHM）占所有皮肤黑素瘤的 2-8%。由于其临床外观和缺乏特定的皮肤镜指标，AHM 的诊断具有挑战性，尤其是在较薄的皮肤病变中。我们研究的目的是评估薄的 AHM 的临床病理和皮肤镜特征。确定薄的 AHM 的基线临床病理特征和皮肤镜特征对于更好地理解这种实体至关重要。
我们根据 Breslow 厚度将 AHM 队列分为两组：薄（≤1.00mm）和厚（>1.00mm）。这种分层有助于确定两组之间是否存在任何显著的临床病理差异。对于皮肤镜分析，我们采用了“模式分析”方法，该方法涉及对不同标准进行同时和主观评估。
在分析 Breslow 厚度的 2800 个黑素瘤中，有 153 个被确定为 AHM。其中，65 例患者表现为薄的 AHM，88 例患者表现为厚的 AHM。薄的 AHM 患者中红发和 II 型光型更为常见。躯干是薄的 AHM 最常见的解剖部位。薄的 AHM 患者中多发性黑素瘤的数量较多。皮肤镜分析显示，除了薄的 AHM 中更频繁地出现残留网纹外，薄的 AHM 和厚的 AHM 之间没有明显差异。
薄的 AHM 通常影响光型和红发颜色较低的个体。这些方面可能与较高含量的 pheomelanin 有关，pheomelanin 对太阳损伤的保护作用有限。这也与躯干是薄的 AHM 的主要解剖部位的事实相关，躯干是一个经常间歇性暴露于阳光的部位。薄的 AHM 患者中多发性原发性黑素瘤更为常见，这可能是由于内在倾向以及此类患者更频繁的定期皮肤科随访所致。除了残留网纹的存在外，没有观察到其他明显的皮肤镜差异，这使得仅凭皮肤镜难以区分薄的和厚的 AHM。
