Santaniello Umberto, Cavallo Francesco, Diana Sara, Giordano Silvia, Crespi Orsola, Rosset François, Agostini Andrea, Moirano Giovenale, Fava Paolo, Quaglino Pietro, Ribero Simone, Broganelli Paolo
Section of Dermatology, Department of Medical Sciences, University of Turin, 10126 Turin, Italy.
Dermatology and Venereology, Ordine Mauriziano "Umberto I" Hospital, 10128 Turin, Italy.
Cancers (Basel). 2025 Sep 19;17(18):3064. doi: 10.3390/cancers17183064.
BACKGROUND/OBJECTIVES: The diagnosis of melanocytic lesions on the trunk is challenging due to a high frequency of atypical features in benign nevi, leading to a high rate of unnecessary excisions. This study aimed to identify robust dermoscopic predictors of cutaneous melanoma on the trunk and to evaluate a novel diagnostic criterion: the orientation of lesions relative to Langer's skin tension lines.
We conducted a retrospective analysis of 321 melanocytic lesions (227 nevi and 94 melanomas) excised from the trunk. Dermoscopic features were systematically evaluated. A chi-square test and an age- and sex-adjusted multivariate logistic regression were performed to calculate odds ratios (OR) and identify independent predictors of malignancy. A subgroup analysis was also conducted on "critical" versus "non-critical" anatomical sites.
Non-adherence to Langer's lines was the most powerful predictor of melanoma (OR 5.55, 95% CI 3.22-9.81; < 0.001). Other significant predictors included blue-white veil (OR 5.09) and polymorphous vessels (OR 4.06). Notably, 70% of melanomas did not align with Langer's lines, whereas 72% of nevi did. Classic features such as scar-like regression were not statistically significant predictors in this cohort. In the subgroup analysis, color asymmetry was a significant predictor of melanoma only in non-critical sites (p for interaction = 0.026).
The orientation of a melanocytic lesion relative to Langer's lines is a powerful and independent predictor of melanoma on the trunk. This simple morphological feature, which may reflect differences in growth patterns between malignant and benign lesions, could serve as an additional clinical cue to support decision-making and improve diagnostic accuracy in this challenging anatomical location.
背景/目的：由于良性痣中存在非典型特征的频率较高，躯干黑素细胞性病变的诊断具有挑战性，导致不必要的切除率很高。本研究旨在确定躯干皮肤黑色素瘤的可靠皮肤镜预测指标，并评估一种新的诊断标准：病变相对于朗格皮肤张力线的方向。
我们对从躯干切除的321例黑素细胞性病变（227例痣和94例黑色素瘤）进行了回顾性分析。系统评估皮肤镜特征。进行卡方检验和年龄及性别调整的多变量逻辑回归，以计算比值比（OR）并确定恶性肿瘤的独立预测指标。还对“关键”与“非关键”解剖部位进行了亚组分析。
不遵循朗格线是黑色素瘤最有力的预测指标（OR 5.55，95%可信区间3.22 - 9.81；P < 0.001）。其他重要预测指标包括蓝白色面纱（OR 5.09）和多形性血管（OR 4.06）。值得注意的是，70%的黑色素瘤与朗格线不一致，而72%的痣与之相符。在该队列中，诸如瘢痕样消退等典型特征并非具有统计学意义的预测指标。在亚组分析中，颜色不对称仅在非关键部位是黑色素瘤的重要预测指标（交互作用P = 0.026）。
黑素细胞性病变相对于朗格线的方向是躯干黑色素瘤有力且独立的预测指标。这一简单的形态学特征可能反映了恶性和良性病变生长模式的差异，可作为一种额外的临床线索，以支持决策制定并提高这一具有挑战性解剖部位的诊断准确性。
