Abstract
Equivocal pigmented lesions of the head are usually biopsied to avoid inappropriate treatment. Clinical approach has evolved from simple visual examination to sophisticated techniques for selecting the biopsy sites. This study aimed to retrospectively evaluate the efficiency of dermoscopy (DE) and reflectance confocal microscopy (RCM) in sampling a histopathologically representative focus of lentigo maligna/lentigo maligna melanoma. Punch biopsies and surgical excisions of 72 patients, 37 men and 35 women (median age 70.6 years, range 39-90 years), affected by lentigo maligna/lentigo maligna melanoma of the head, sent from a single dermatology clinic, were reviewed for the presence of 5 histopathologic criteria: atypical junctional melanocytes, increased junctional melanocytes, follicular colonization, pagetoid spread and melanocytic junctional nests, plus other minor features. Forty-two patients were biopsied under DE and 30 under RCM guidance. Accuracy of the 2 techniques in sampling a representative tissue overlapped in most cases, although RCM selected sites to biopsy with more histopathologic criteria, in particular pagetoid spread and melanocytic nests. Interestingly, with RCM, inflammation and melanophages were observed more in biopsy than in excision. False positive cases were not registered. Compared with the sampling at naked eye, our results show that DE and RCM help selecting the most appropriate areas for biopsies, thus allowing not only more robust histopathologic diagnoses, but also a more accurate microstaging of tumor.
Highlights
Pigmented lesions on sun-damaged skin represent difficult entities to diagnose for clinicians, given their overlapping features.[1]
Accuracy of the 2 techniques in sampling a representative tissue overlapped in most cases, reflectance confocal microscopy (RCM) selected sites to biopsy with more histopathologic criteria, in particular pagetoid spread and melanocytic nests
Compared with the sampling at naked eye, our results show that DE and RCM help selecting the most appropriate areas for biopsies, allowing more robust histopathologic diagnoses, and a more accurate microstaging of tumor
Summary
Pigmented lesions on sun-damaged skin represent difficult entities to diagnose for clinicians, given their overlapping features.[1]. MD, Department of Anatomic Pathology, malignant melanoma in an early phase to ensure the best treatment and prognosis for the patient.[2] Currently, excisional biopsy is the recommended diagnostic procedure for lentigo maligna (LM) and LM/melanoma (LMM).[3] to avoid esthetic damage in cosmetically sensitive areas and offer a diagnosis close to certainty, a previous biopsy is recommended.[4] In the past, simple visual inspection was the method to select the focus to sample. In a dermatologists’ survey, the most frequent clinical criteria of biopsy resulted: darkest area, indurated or papulonodular area, and referring changed area.[5] This method at naked eye, applied in a study of 46 melanocytic lesions on sun-damaged skin by Somach et al,[5] resulted in 40% of cases containing more histopathologic features in excisional specimens than biopsies; in particular, dermal invasion at biopsy was a feature missed in approximately 20% of cases. Clinical approach has evolved from simple visual examination to sophisticated techniques for selecting the biopsy sites
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