Dermoscopic-pathologic correlation: an atlas of 15 cases

Abstract

In recent years, dermoscopy has become the conceptual and practical link between clinical and histopathologic examination of any pigmented skin lesion (PSL): in a melanocytic neoplasm (MN) as well as in a nonmelanocytic neoplasm (nMN), dermoscopy may give a great diagnostic aid, inasmuch as it allows the clinicians to visualize structures that would be otherwise not discernible by the naked eye. By definition, dermoscopy is a “skin surface microscopy”—ie, it cannot allow the clinician to detect what is located below the superficial dermis. Despite this limitation, however, it carries a very high sensitivity and specificity in the preoperative diagnosis of PSLs.[1, 2 and 3] Actually, dermoscopic and histopathologic interobserver agreement in the diagnosis of MNs is statistically related. When at least one dermoscopist disagrees with his colleagues in evaluating an MN, even histopathologic consultations may give equivocal results. [4 and 5] The dermoscopic diagnosis of an MN is primarily based on the recognition of a “global” dermoscopic pattern (ie, reticular, globular, cobblestone, homogeneous, “starburst,” parallel, multicomponent, unspecific). Each global dermoscopic pattern arises from the sum of “local” dermoscopic features, and each local dermoscopic feature has its own histopathologic correlate(s).[6. H.P. Soyer, J. Smolle, S. Hoedl et al., Surface microscopy: a new approach to the diagnosis of cutaneous pigmented tumors. Am J Dermatopathol 11 (1989), pp. 1–10. View Record in Scopus | Cited By in Scopus (105)6, 7 and 8] In sum, the final dermoscopic diagnosis and its interobserver reproducibility, as well as all of the single (“local”) dermoscopic features are closely correlated with histopathology. In the present article, some guidelines are provided for performing a dermoscopic-pathologic correlation study; thereafter, a case-by-case correlation is accomplished to illustrate some stereotypical dermoscopic-pathologic features of both MNs and nMNs.