Linear Irregular Vessels Research Articles

Dermoscopic Evolution of Vascular Pattern in Two Cases of Amelanotic Melanoma

Hypo/amelanotic skin lesions present a diagnostic chal-lenge, and dermoscopic analysis can often help in deter-mining whether a lesion is benign or malignant (1–3). The presence of a vascular pattern characterized by poly-morphic vessels, such as hairpin-like, pinpoint and linear irregular vessels, may be the only significant dermoscopic finding of amelanotic melanoma (AM) (4).As described previously, morphological changes in dermoscopic patterns have been associated with the characteristic evolution of benign melanocytic naevi after a long-term follow-up of 12 months (5, 6). Rapid and irregular modifications often suggest malignancy (6). The diagnosis of early-phase AM is especially challenging. We report here two cases of AM characterized by der-moscopic changes in vascular pattern observed during a follow-up period of 6–10 months after the initial visit.CASE REPORTS

Dermoscopic features of acral lentiginous melanoma in a large series of 110 cases in a white population

Acral lentiginous melanoma (ALM) is a rare but distinctive subtype of melanoma. The diagnosis is often delayed and misdiagnosis is common, due to frequently unusual clinical presentation and a higher rate of amelanosis than in other melanoma subtypes. We aimed to investigate the dermoscopic features of a large series of ALM in a white-skinned population, in order to emphasize their diagnostic value. All recorded dermoscopic photographs of ALM, including nail unit variants, were collected from the files of the University Hospital Department of Dermatology (Lyons, France) and reviewed. In total 110 lesions, including 66 (60%) palmoplantar ALM and 44 (40%) ALM of the nail apparatus, were analysed for dermoscopic characteristics. The mean Breslow thickness was 2.6 mm. In volar skin melanomas, the two most prevalent patterns were irregular diffuse pigmentation (60%) and the parallel-ridge pattern (53%). Minor dermoscopic patterns, commonly noted in benign lesions, were also detected but only focally within the lesions. Among the 44 nail unit lesions, 31 (70%) presented irregular lines with variegations in colours, spacing, width and disruption of parallelism. Two cases of melanonychia striata had a triangular shape. Both corresponded to early ungual ALM. Association with subungual haemorrhage was not uncommon. The study included 37 (34%) amelanotic melanomas. However, dermoscopy enabled detection of microscopic remnants of pigmentation in most cases. The vascular pattern found in almost half of these lesions was polymorphous, with combinations of milky-red areas (95%), linear irregular vessels (49%), dotted vessels (43%) and hairpin vessels (41%). The presence of a parallel-ridge pattern and/or irregular diffuse pigmentation within the lesion is highly indicative of melanoma on volar skin. An irregular lines pattern is the most prominent dermoscopic feature of pigmented ALM of the nail apparatus. Amelanotic ALM either in volar skin or in nail apparatus is characterized by remnants of pigmentation and a polymorphic vascular pattern.

Eccrine Poroma: A Clinical-Dermoscopic Study of Seven Cases

Eccrine poroma can mimic benign and malignant melanocytic and non-melanocytic lesions. To date, little is known about the dermoscopic features of this condition. Seven histopathologically proven cases of eccrine poroma were examined using dermoscopy by three independent dermatologists. Both glomerular and hairpin vessels were observed in 71% of cases, whereas linear irregular vessels were observed in 43% of cases. A white-to-pink halo surrounding the vessels and multiple pink-white structureless areas were also frequently found (in 86% and 71% of cases, respectively). Three dermoscopic "profiles" were identified, all characterized by the presence of a white-to-pink halo surrounding the vessels, as well as by the association of two additional different features, namely: glomerular vessels and pink-white structureless areas, glomerular and linear irregular vessels, hairpin vessels and linear irregular vessels. However, due to the small number of lesions studied so far, we suggest that these profiles should be considered as likely, but not definitely pathognomonic signs of eccrine poroma.

Dermoscopy of cutaneous leishmaniasis

Dermoscopy has been proposed as a diagnostic tool in the case of skin infections and parasitosis but no specific dermoscopic criteria have been described for cutaneous leishmaniasis (CL). To describe the dermoscopic features of CL. Dermoscopic examination (using the DermLite Foto; 3Gen, LLC, Dana Point, CA, U.S.A.) of 26 CL lesions was performed to evaluate specific dermoscopic criteria. We observed the following dermoscopic features: generalized erythema (100%), 'yellow tears' (53%), hyperkeratosis (50%), central erosion/ulceration (46%), erosion/ulceration associated with hyperkeratosis (38%) and 'white starburst-like pattern' (38%). Interestingly, at least one vascular structure described in skin neoplasms was observed in all cases: comma-shaped vessels (73%), linear irregular vessels (57%), dotted vessels (53%), polymorphous/atypical vessels (26%), hairpin vessels (19%), arborizing telangiectasia (11%), corkscrew vessels (7%) and glomerular-like vessels (7%). Combination of two or more different types of vascular structures was present in 23 of 26 CL lesions (88%), with a combination of two vascular structures in 13 cases (50%) and three or more in 10 cases (38%). Characteristic dermoscopic structures have been identified in CL. Important vascular patterns seen in melanocytic and nonmelanocytic tumours are frequently observed in this infection.

Dermoscopic Findings of Pilomatricomas

Background: To the best of our knowledge, no specific dermoscopic criteria have been described in the medical literature for the diagnosis of pilomatricomas. Objectives: To evaluate the morphological findings of pilomatricomas under dermoscopic observation. Material and Methods: Dermoscopic examination (using the Dermlite Foto; 3Gen, LLC, Dana Point, Calif., USA) of 10 patients with pilomatricomas was performed to evaluate specific dermoscopic criteria and patterns. Results: The most frequently occurring dermoscopic features were found to be: irregular white structures (80%) and white streaks (70%); vascular structures in all lesions (reddish homogeneous area in 90%, hairpin vessels in 70%, linear-irregular vessels in 70% and dotted vessels in 40%); ulceration (60%), and structureless gray-blue areas in 20% of cases. The results of our study reveal that the absence of specific dermoscopic criteria for other skin tumors and the presence of irregular white structures and polymorphous/atypical vessels is the most frequent dermoscopic pattern in pilomatricomas. Conclusions: Dermoscopy may be a useful tool for improving the recognition of pilomatricomas. However, dermoscopy does not assure 100% diagnostic accuracy and pilomatricomas may represent in some cases, above all in elderly patients, a dermoscopic pitfall, being difficult to differentiate dermoscopically from other lesions, such as melanoma or basal cell carcinoma.

Dermoscopy of desmoplastic melanoma: report of six cases

Desmoplastic melanoma (DM) is a rare variant of cutaneous melanoma. Its diagnosis is often delayed by an unusual clinical presentation. The dermoscopic features of DM have not yet been described. To define the dermoscopic features of DM. Patients and methods A single-institution register-based retrospective study of six cases of histology-proven desmoplastic melanoma for which dermoscopy data were available. The criteria we studied included: network, dots and globules, streaks, regression features, ulceration, number of colours, blue/white veil, and vascular pattern. Only three cases exhibited one classical feature for a melanocytic lesion; other cases were recognized on the basis of the presence of figures of regression (all six), i.e. white scar-like areas and 'peppering' (three of six), multiple (> 4) colours (five of six), and of melanoma-related vascular patterns (five) such as linear-irregular vessels (four) and milky-red areas (two). We believe that dermoscopy could help in the accurate diagnosis of this rare neoplasm. In the absence of a pigmented network, attention should be given to the identification of features of regression and to melanoma-associated vascular patterns.

Basal Cell Carcinoma with Fibroepithelioma‐like Histology in a Healthy Child: Report and Review of the Literature

We report the case of a 13-year-old girl with a 7 mm plaque on the trunk. The mother of the patient reported that the lesion developed at the age of 3 and it was characterized by a slow growth. In 2003 a dermoscopic examination was executed and a diagnosis of dermical nevus was made. On examination at our department, a red-pinkish plaque with two small areas of ulceration was found on the anterior part of the trunk. At dermoscopic examination we observed vascular pattern with linear-irregular vessels, multiple blue-gray dots, blue-gray ovoid nests, and ulceration. A diagnosis of basal cell carcinoma was made and confirmed by histopathologic examination. The histopathologic specimen showed nests or lobules of basalioid cells associated with a surrounding loose fibromucinous stroma; two patterns were observed: adenoid-cystic and fibroepithelial. Some fibroepithelioma of Pinkus-like areas were present, where the fibrovascular stroma was very abundant with an arborizing network of long, thin cords of basaliod cells that extended downward from the epidermis and created a fenestrating pattern. The lesion was surgically excised. Basal cell carcinoma occurs rarely in children and is most often associated with an underlying condition that predisposes patients to the development of malignancy that was not present in our case.

Dermoscopy of fully regressive cutaneous melanoma

Metastatic melanoma of unknown origin is a difficult challenge diagnostically and therapeutically. Diagnosis of the putative primary lesion is difficult. This difficulty increases when the primary lesion has undergone complete regression. To define the dermoscopic features of fully regressed melanoma. A single-institution, register-based study of an unselected consecutive series of seven cases of metastatic melanoma in the lymph nodes with no known or visible primary lesion was carried out. Skin examination included dermoscopy; when a suspicious area was found, observed dermoscopic features were recorded and a biopsy was performed. Diagnosis of completely regressive cutaneous melanoma was based on clinical-pathological correlation according to widely accepted criteria. Seven dermoscopic features were associated with completely regressive melanoma: scar-like depigmentation (100%); pink coloration of the background (100%); linear-irregular vessels (86%); globular pattern of the vessels (43%); remnants of pigmentation (86%), either macular (43%) or with a peppering aspect (43%); and white lighter transverse bands (43%). The last feature was only observed with polarized light dermoscopy devices. Dermoscopy more accurately distinguishes the vascular, pigmentary and scarring changes of fully regressive melanoma. We believe that dermoscopy should be included in the search for a regressive primary lesion in case of metastatic melanoma of unknown origin.

Amelanotic/hypomelanotic melanoma: clinical and Dermoscopic features

Background Amelanotic malignant melanoma is a subtype of cutaneous melanoma with little or no pigment at visual inspection. Truly amelanotic melanomas are rare: often some pigmentation is present at the periphery of the lesions and the amelanotic/hypomelanotic melanoma (AHM) mimics benign and malignant variants of both melanocytic and non melanocytic lesions. We conducted a study to learn more about the clinical and the dermoscopic features of this melanoma and to investigate the possibility of differentiating it from amelanotic/hypomelanotic benign melanocytic lesions (AHBML) and from amelanotic/hypomelanotic non melanocytic lesions (AHNML). Methods Digitized images of 151 amelanotic/hypomelanotic skin lesions were sent by e-mail from participating centers. Lesions included 55 (AHNML), 52 (AHBML) and 44 AHM divided into thin melanomas (TnM) ≤1 mm (29 cases) and thick melanomas (TkM) >1 mm (15 cases), according to Breslow index. Clinical features and dermoscopic criteria were evaluated in order to achieve clinical and dermoscopic diagnosis. Results The most frequent and significant clinical features for TnM and TkM were asymmetry and ulceration (the latter only for TkM) compared with AHBML but these clinical features were also detected in AHNML without statistically significant differences in their frequency in the two groups. Irregular dots/globules (62% vs 35%; P≤0.03), regression structures (48% vs 27%; P≤0.03), irregular pigmentation (41% vs 11%; P≤0.03) and blue-whitish veil (10% vs 0%; P≤0.03) were the most relevant dermoscopic criteria for TnM in comparison with AHBML. TkM differed significantly from AHBML in the incidence of irregular pigmentation (87% vs 11%; P≤0.03), irregular dots/globules (73% vs 35%; P≤0.03), regression structures (67% vs 27%; P≤0.03), blue-whitish veil (27% vs 0%; P≤0.03) and hypopigmentation (13% vs 55%; P≤0.03). Linear irregular vessels and the combination of dotted and linear irregular vessels were associated with TnM and TkM but were not found in our cases of AHBML. The area under the curve for dermoscopic diagnosis was greater than the one for clinical diagnosis and dermoscopic diagnosis of melanoma had higher sensitivity and higher specificity than clinical diagnosis (89% and 96% vs 65% and 88% respectively). Conclusion Clinical features routinely used for diagnosing melanoma such as peripheral pigmentation, ulceration, and asymmetry, are not really helpful in diagnosing amelanotic/hypomelanotic melanomas. Because dermoscopy uses criteria reflecting both pigmentation (irregular pigmentation, and irregular dots/globules) and vascular patterns, it is a useful technique not only forffpigmented melanoma but also for amelanotic/hypomelanotic melanoma.