Clinical and dermoscopic characteristics of melanomas on nonfacial chronically sun-damaged skin

• Published in: Journal of the American Academy of Dermatology Vol. 72; no. 6; pp. 1027 - 1035
• Main Authors: Jaimes, Natalia, MD, Marghoob, Ashfaq A., MD, Rabinovitz, Harold, MD, Braun, Ralph P., MD, Cameron, Alan, MBBS, Rosendahl, Cliff, MBBS, PhD, Canning, Greg, MBBS, Keir, Jeffrey, MBBS, MFamMed
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.06.2015
• Subjects: actinic damage; Adult; Age Distribution; Aged; Australia - epidemiology; Cohort Studies; Dermatology; dermoscopy; Dermoscopy - methods; Early Detection of Cancer - methods; Female; Humans; Hutchinson's Melanotic Freckle - epidemiology; Hutchinson's Melanotic Freckle - etiology; Hutchinson's Melanotic Freckle - pathology; Incidence; lentigo maligna; Male; melanoma; Melanoma - epidemiology; Melanoma - etiology; Melanoma - pathology; Middle Aged; Neoplasm Invasiveness - pathology; Neoplasm Staging; Prognosis; Retrospective Studies; Risk Assessment; Sex Distribution; Skin Neoplasms - epidemiology; Skin Neoplasms - etiology; Skin Neoplasms - pathology; sun-damaged skin; Sunlight - adverse effects; ultraviolet radiation; Ultraviolet Rays - adverse effects; Australia; CSDS; LM; lentigo maligna; sun-damaged skin; melanoma; SSM; ultraviolet radiation; patchy peripheral pigmented islands; actinic damage; chronically sun-damaged skin; PPPI; superficial spreading melanoma; dermoscopy
• ISSN: 0190-9622; 1097-6787
• DOI: 10.1016/j.jaad.2015.02.1117

Background Melanomas on chronically sun-damaged skin (CSDS) can be difficult to identify and often manifest morphologic features that overlap with benign lesions. Objective We describe and analyze the clinical and dermoscopic characteristics of melanomas on nonfacial CSDS. Methods Melanoma cases on nonfacial CSDS were retrospectively identified from the biopsy specimen logs of 6 melanoma clinics. Clinical and dermoscopic images were combined into 1 database. Demographics, clinical, dermoscopic, and histopathologic information were analyzed. Descriptive frequencies were calculated. Results One hundred eighty-six cases met the inclusion criteria: 142 melanomas in situ (76%) and 39 invasive (21%; mean thickness, 0.49 mm). Lentigo maligna was the most common histopathologic subtype (n = 76; 40.9%). The most frequent dermoscopic structures were granularity (n = 126; 67.7%) and angulated lines (n = 82; 44%). Vascular structures were more frequent in invasive melanomas (56% vs 12% of in situ melanomas). Most manifested 1 of 3 dermoscopic patterns: patchy peripheral pigmented islands, angulated lines, and tan structureless with granularity pattern. Limitations This was a retrospective study, and evaluators were not blinded to the diagnosis. In addition, interobserver concordance and sensitivity and specificity for dermoscopic structures were not evaluated. Conclusion Outlier lesions manifesting dermoscopic structures, such as granularity, angulated lines, or vessels and any of the 3 described dermoscopic patterns should raise suspicion for melanoma.