Lentigo maligna and lentigo maligna melanoma in-vivo differentiation with dermoscopy and reflectance confocal microscopy: a retrospective, multi-center study.

Abstract

Dermoscopic predictors of lentigo maligna (LM) and lentigo maligna melanoma (LMM) have been recently reported, but these have not been reported in reflectance confocal microscopy (RCM). (i) To validate dermoscopic predictors for LM/LMM, (ii) to identify RCM patterns in LM and LMM and (iii) correlations between dermoscopic and RCM features in LM and LMM. A retrospective, multicenter study of consecutive lesions with histologically proven LM or LMM subtypes of the head and face, with complete sets of dermoscopic and RCM images. A total of 180 lesions were included (n=40 LMM). Previously reported differential dermoscopic features for LM subtypes were confirmed. Other features significantly associated with LMM diagnosis included irregular hyperpigmented areas, shiny white streaks, atypical vessels, and light brown color at dermoscopy and medusa head-like structures, dermal nests and nucleated cells within the papillae at RCM (p<0.05). Correlations among LM lesions between dermoscopic and RCM features included brown to-gray dots and atypical cells (epidermis), grey color and inflammation and obliterated follicles and medusa head-like structures. Among LMM lesions, significant correlations included obliterated follicles with folliculotropism, both irregular hyperpigmented areas and irregular blotches with widespread atypical cell distribution (epidermis), dermal nests and nucleated cells within the papillae (dermis). Irregular blotches were also associated with medusa head-like structures (dermal epidermal junction [DEJ]). Dermoscopic and RCM features can assist in the in-vivo identification of LM histopathological subtypes and many are correlated. RCM 3-dimensional analysis of skin layers allows the identification of invasive components in the DEJ and dermis.