Peripheral Globules Research Articles

Rapid involution of a melanocytic lesion with peripheral globules.

Rapid involution of a melanocytic lesion with peripheral globules.

Can we manage the melanocytic lesions with peripheral globules according to the grade of dysplasia?

Although excision of melanocytic nevi with high-grade dysplasia is recommended by the World Health Organization (WHO), clinical studies investigating the approach based on the grading dysplasia of melanocytic lesions with peripheral globules (PGs) are lacking. We investigated the grades of dysplasia and their distinguishable dermoscopic and clinical features to provide accurate data for managing these lesions. We retrospectively classified histologically confirmed melanocytic lesions with PGs according to the 2018 WHO Classification of Skin Tumours criteria in a university hospital in Turkey. Dermoscopic features, lesions, and patient characteristics were recorded. Sixty-six lesions of 56 patients were included. After classification, 9.1% (n: 6) of lesions were melanomas, 39.4% (n: 26) were high-grade dysplastic nevi, and 50% (n: 33) were low-grade dysplastic nevi (n: 33, 50%). There was one nevus with no dysplasia (n: 1, 1.5%). Univariate analysis revealed that ≥31 years of age, irregular shape of peripheral globules, black colour, total colour count, and maximum diameter of the lesion were associated with high-grade dysplasia and melanoma. In the multivariate analyses, ≥31 years of age (OR = 3.80, 95% CI, 1.17-12.37), irregular shape of peripheral globules (OR = 3.90, 95% CI, 1.15-13.2), and total colour count (OR = 3.21, 95% CI, 1.2-8.5) were significant predictive factors for the lesions with high-grade dysplasia and melanomas. To avoid the underdiagnosis of both melanomas and high-grade dysplastic nevi with PGs, the irregular shape of peripheral globules and multiple colours after the third decade may be useful in making an excision decision. The risk increases every 1-year increase in age. Excision is suggested for all melanocytic lesions with PGs for patients 60 years or older because of the high risk of melanoma and melanocytic nevus with high-grade dysplasia.

The Natural Evolution of Nevi with Peripheral Globules

Background: Peripheral globules (PG) in melanocytic lesions represent a concerning dermoscopic feature since they might be present in growing nevi and melanomas. Their natural evolution has not been fully elucidated, and an age-based management approach has been recommended. Objectives: The aim of this study was to calculate the growth rate of lesions with PG and investigate possible association with age, sex, location, and the global dermoscopic pattern. Methods: We retrospectively selected the lesions of interest from a cohort of Caucasian patients who underwent sequential digital dermoscopy monitoring. Lesions with PG distributed at 75% or more of their circumference with available follow-up images or histopathologic report were included. The surface area was automatically calculated with the help of an incorporated tool used in the acquisition of the images. The images were also evaluated by independent investigators for the presence of pre-defined criteria. Growth-curve models were used to assess the growth rate. The outcome variable was the area of nevi in mm², and scatterplots with Lowess curves were used to present the mean change of nevi during follow-up. Results: A total of 208 lesions from 98 patients with a median age of 36 years (range 15–75) were included. The median follow-up time was 18 months (range 4–48). The mean growth rate for all nevi was 0.16 mm²/month (95% CI, 0.14–0.18, p < 0.001), ranging from −0.29 to 0.61 mm²/month. The growth rate was higher in nevi with a homogeneous dermoscopic pattern (p < 0.001). The number of peripheral globules during follow-up varied from increasing to complete disappearance. None of the lesions developed any melanoma-specific structure at follow-up. Conclusion: Nevi with PG grew at a mean rate of 0.16 mm²/month, and the growth rate was independent of age, gender, or anatomic location. Nevi with homogeneous pattern demonstrated the highest growth rate in our cohort. None of the monitored nevi with PG developed melanoma-specific criteria at follow-up.

Melanocytic Lesions with Peripheral Globules: Proposal of an Integrated Management Algorithm.

A peripheral rim of globules represents a marker of the horizontal growth phase in nevi and is a common feature in children and adolescents. The observation of melanocytic lesions with peripheral globules (MLPGs) in adulthood deserves more attention, since melanoma may exhibit this feature, albeit rarely. Risk-stratified management recommendations considering a global clinical approach are still missing. To analyze current knowledge on MLPGs and propose an integrated management algorithm stratified for age groups. We conducted a narrative review of current published data on MLPGs, analyzing clinical dermoscopic and confocal distinguishing features of melanoma from benign nevi. The risk of finding a melanoma when removing an MLPG increases with age, especially in people >55 years old, and is significantly higher in the extremities, head/neck and in case of a single asymmetrical lesion, ≥6 mm in diameter. Dermoscopic features associated with melanoma diagnosis include atypical peripheral globules, asymmetrical distribution, multiple rims as well as the reappearance of globules after prior loss. In addition, wide blue-grey regression areas, atypical networks, eccentric blotches, tan structureless peripheral areas and vascularization are atypical dermoscopic features. Confocal worrisome findings are represented by pagetoid cells within the epidermis, architectural disarrangement and atypical cells of the dermo-epidermal junction with irregular peripheral nests. We proposed a multi-step age-stratified management algorithm integrating clinical, dermoscopic and confocal findings that may increase the early recognition of melanoma and avoid surgical excision of benign nevi.

Melanoma with peripheral globules: Clinical and dermatoscopic features

The morphology and biology of nevi with peripheral globules are well known, whereas those of melanomas with peripheral globules remain unclear. Comparing the dermatoscopic characteristics of nevi and melanomas with peripheral globules. A total of 401 melanocytic lesions with peripheral globules were included in this retrospective study. Dermatoscopic patterns and structures, including those of peripheral globules, were evaluated. A generalized estimating equation model with a binomial distribution dependent variable and logit link function was fitted to the dataset to identify features with the highest odds of differentiating melanoma from nevi. Of the 401 lesions, 179 (44.64%) were excised, 41 (10.22%) of which were melanomas. Melanomas were most common in the lower extremities (P<.01), with a disorganized pattern, whereas melanocytic nevi were most common on the trunk, with an organized pattern. In addition, the presence of blotches, atypical dots and globules, or atypical vessels was associated with melanomas (P<.01). The retrospective design of the study may have caused an inclusion bias. Melanocytic lesions displaying peripheral globules are at the greatest risk of melanoma if located on the lower extremity and if lesions reveal any of the following structures: blotch, atypical dots and globules, or atypical vessels.

Enlarging melanocytic lesions with peripheral globular pattern: a dermoscopy and confocal microscopy study.

BACKGROUND Enlarging melanocytic lesions with peripheral globular pattern (EMLPGP) are a pitfall in dermoscopy. Our aim was to evaluate the meaning of EMLPGP and to assess the use of dermoscopy and reflectance confocal microscopy (RCM) in order to improve the clinical management of this subtype of melanocytic lesions. METHODS A total of 135 EMLPGP were recruited and, accordingly to the dermoscopy features, were removed; later, an expert dermoscopist reviewed the lesions blinded to histology. Moreover, a subgroup of 63 lesions who underwent also to RCM, were reviewed by an expert confocalist. RESULTS Patients had a median age of 41 years old and a female prevalence (61.5%). The main anatomic site was the trunk (86%). Histology of the 135 excised EMLPGP disclosed 116 nevi (86%; P<0.0001) and 19 melanomas (14%). On dermoscopy, statistical significance was detected for small globules that were observed in 106 cases (78.5%; P<0.0001), while globules distribution and color did not impact the diagnosis prediction, as well as age, sex or any other patient profile. Considering the RCM, atypical cytology and irregular architecture were detected in 100% of melanomas (P<0.0001). CONCLUSIONS Our study shows that EMLPGPs are detectable in every age and can be a pitfall in especially in high risk patients with an over-excision of lesions. The presence of peripheral globules should be evaluated considering the overall dermoscopic features. RCM can contribute significantly in the management of lesions trough the detection of cyto-architectural atypia. Therefore, RCM in combination with dermoscopy can optimize the reduction of harmless lesions.

Melanocytic lesions with peripheral globules: still a pitfall in the differential diagnosis of melanoma.

Linked article: A. Pampín–Franco et al. J Eur Acad Dermatol Venereol 2021; 35: 1133–1142. https://doi.org/10.1111/jdv.17105.

Melanocytic lesions with peripheral globules: results of an observational prospective study in 154 high-risk melanoma patients under digital dermoscopy follow-up evaluated with reflectance confocal microscopy.

The management of melanocytic lesions with peripheral globules (MLPGs) is usually age-dependent and can be challenging in high-risk melanoma patients. To evaluate clinical, dermoscopic and reflectance confocal microscopy (RCM) features of MLPG in patients under digital dermoscopic surveillance. To know whether dermoscopic or RCM findings correlate with histologic diagnosis and the accuracy of the dermoscopy-RCM compared with histopathology. During 24 months, we prospectively enrolled MLPG in patients under digital dermoscopy follow-up. All were evaluated by dermoscopy and RCM and excised for histologic examination. We enrolled 154 patients, mean age 42.45years (18.78-73.19). Three melanomas and 19 dysplastic naevi (DNs) were diagnosed. There were no significant differences in the age of the patients (P=0.662). MLPGs with diameter of 6mm or more and asymmetry in two axes were associated with melanoma (P=0.01, P=0.003). Patients with more than one MLPG were less likely to have melanoma. Blue-grey and red colours were more frequent in melanoma (P=0.013 and P=0.000). Different sizes and shapes of PG were associated with DN and melanoma (P=0.000 and P=0.001). In a new lesion, PG in <25% of the circumference was related to malignancy (P=0.010). RCM signs of malignancy were related to melanoma: pagetoid cells (P=0.000), non-edged papillae (P=0.001), atypical junctional thickenings (P=0.000) and atypical cells at the dermal-epidermal junction (P=0.000). Dense irregular nests were associated to melanoma (P=0.019). Dermoscopy and confocal evaluation were able to diagnose 100% of melanomas and 84.21% of DNs. The kappa coefficient between dermoscopy-RCM vs. histology was 0.76. We recommend to excise a MLPG when it presents asymmetry in two axes, 6 or more mm, new lesion with PG in less than the 25% of the circumference, irregular size and shape PGs and irregular dense nests on RCM, regardless of the patient's age.

Association between the dermoscopic morphology of peripheral globules and melanocytic lesion diagnosis.

The presence of peripheral globules is associated with enlarging melanocytic lesions; however, there are numerous patterns of peripheral globules distribution and it remains unknown whether specific patterns can help differentiate enlarging naevi from melanoma. To investigate whether morphological differences exist between the peripheral globules seen in different subsets of naevi and in melanoma. A cross-sectional study of clinical notes that mentioned peripheral globules, in addition to all melanoma images with peripheral globules on the International Skin Imaging Collaboration archive. Dermoscopic images were reviewed and annotated. Associations between diagnosis and categorical features were measured with odds ratios. Non-parametric tests were used for continuous factors. 184 lesions with peripheral globules from our clinic were included in the analysis; only 6 of these proved to be melanoma. 109 melanomas with peripheral globules from the International Skin Imaging Collaboration archive were added to the analysis. Melanomas were more common on the extremities and among older individuals. Melanomas were more likely to display atypical, tiered and/or focal peripheral globules. Only 5% of melanomas lacked dermoscopic melanoma-specific structures compared to 48% of naevi. Melanocytic lesions with atypical or asymmetrically distributed peripheral globules, especially when located on the extremities, should raise suspicion for malignancy. Melanocytic lesions with typical and symmetrically distributed peripheral globules, and with no other concerning dermoscopic features, are unlikely to be malignant.

Diagnostic utility of circumferential peripheral globules under dermoscopy in adults

To the Editor: Circumferential peripheral globules (CPG) are an uncommon finding in the dermoscopic evaluation of melanocytic lesions and have been suggested to represent growth.1Bajaj S. Dusza S.W. Marchetti M.A. et al.Growth-curve modeling of nevi with a peripheral globular pattern.JAMA Dermatol. 2015; 151: 1338-1345Crossref PubMed Scopus (23) Google Scholar, 2Kittler H. Seltenheim M. Dawid M. Pehamberger H. Wolff K. Binder M. Frequency and characteristics of enlarging common melanocytic nevi.Arch Dermatol. 2000; 136: 316-320Crossref PubMed Scopus (141) Google Scholar, 3Rubegni P. Sbano P. Burroni M. et al.Melanocytic skin lesions and pregnancy: digital dermoscopy analysis.Skin Res Technol. 2007; 13: 143-147Crossref PubMed Scopus (35) Google Scholar They are mostly seen in childhood and are cited to seldomly occur after age 60 years.4Zalaudek I. Schmid K. Marghoob A.A. et al.Frequency of dermoscopic nevus subtypes by age and body site: a cross-sectional study.Arch Dermatol. 2011; 147: 663-670Crossref PubMed Scopus (90) Google Scholar Management of these lesions is mainly based on age. In younger individuals, lesions with CPG are often monitored. In older patients, however, biopsy is frequently performed.4Zalaudek I. Schmid K. Marghoob A.A. et al.Frequency of dermoscopic nevus subtypes by age and body site: a cross-sectional study.Arch Dermatol. 2011; 147: 663-670Crossref PubMed Scopus (90) Google Scholar The objective of this study was to describe the diagnostic accuracy and dermoscopic features of melanocytic lesions with CPG among adults and to identify candidate features to differentiate nevi from melanoma. The International Skin Imaging Collaboration database (www.isic-archive.com) was searched for dermoscopic images of melanocytic lesions with CPGs in November 2019. CPGs were defined as circular clods distributed around the lesion in at least 3 of 4 quadrants. Lesions in patients 20 years or younger and duplicate images were excluded. One author with expertise in dermoscopy was prompted to give a diagnosis for a lesion with 1) only the dermoscopic image and 2) the dermoscopic image plus context (patient age). Melanoma-specific structures were scored as present/absent by 3 dermatologists blinded to age and diagnosis. A structure was considered present if identified by 2 of the 3 reviewers. Of 20,748 images of melanocytic lesions, 238 (1.1%) met the inclusion criteria (Table I). After eliminating lesions in patients 20 years or younger, 99 (0.5%) images remained: 4 melanomas (4.0%) and 95 nevi (96.0%). The melanomas occurred in individuals aged 30, 35, 40, and 55 years. After dichotomizing by age 50 years, there was no difference in the proportion of melanomas (5.3% vs 3.9%; P >.99).Table IPresence of peripheral globules under dermoscopy by age groupAge group, yNevi, n (%)Melanoma, n (%)Total, n (%)Sensitivity (dermoscopy only), %Sensitivity (dermoscopy plus context), %Specificity (dermoscopy only), %Specificity (dermoscopy plus context), %(n = 234)(n = 4)(N = 238)<20139 (59.4)0 (0)139 (58.4)————20-2921 (9.0)0 (0)21 (8.8)10066.784.980.830-3933 (14.1)2 (50)35 (14.7)40-4919 (8.1)1 (25)20 (8.4)50-596 (2.6)1 (25)7 (2.9)089.510015.860-699 (3.8)0 (0)9 (3.8)70-792 (0.9)0 (0)2 (0.8)80-892 (0.9)0 (0)2 (0.8)Unknown3 (1.3)0 (0)3 (1.3)———— Open table in a new tab The overall sensitivity and specificity of diagnosing melanoma given only a dermoscopic image were 75% and 86.3%, respectively. After the addition of context (i.e. age), the sensitivity remained at 75%, but the specificity decreased to 67.4%. All melanomas and 76.8% of nevi had at least 1 melanoma-specific structure. Structures more prevalent among melanomas included off-center blotches (odds ratio, 88.0; 95% confidence interval, 6.95-1114.65; P = .0005) and peripheral tan structureless areas (odds ratio, 14.83; 95% confidence interval, 1.04-212.48; P = .047) (Fig 1). The diagnostic utility of CPG in differentiating nevi from melanoma in adults is unclear. Unlike Zalaudek et al,4Zalaudek I. Schmid K. Marghoob A.A. et al.Frequency of dermoscopic nevus subtypes by age and body site: a cross-sectional study.Arch Dermatol. 2011; 147: 663-670Crossref PubMed Scopus (90) Google Scholar who did not identify peripheral globules in patients 60 years and older, we found 6% to be in this group, none of which were melanomas. Although close observation or excision has been recommended in patients 50 years and older,4Zalaudek I. Schmid K. Marghoob A.A. et al.Frequency of dermoscopic nevus subtypes by age and body site: a cross-sectional study.Arch Dermatol. 2011; 147: 663-670Crossref PubMed Scopus (90) Google Scholar this age cutoff was not associated with melanoma in our study. Furthermore, when clinical context was added, the reader actually decreased specificity without changing sensitivity. Lesions with peripheral globules exhibiting any melanoma-specific structure should be excised, independent of age. Based on our data, the presence of off-centered blotches with tan structureless areas in a lesion with peripheral globules may be a useful diagnostic clue for melanoma. In addition, evaluation of the organization and symmetry of structures and colors provides valuable information. Limitations of our study include its retrospective type and the inclusion bias of preselected lesions for imaging. Overall, these results highlight the need for larger studies to reassess the management of melanocytic lesions with peripheral globules in older patients.

Predictive value of global dermoscopic pattern in patients diagnosed with cutaneous melanoma.

IntroductionDermoscopy is one of the most commonly used methods in early diagnosis of melanoma. It is conducted to differentiate between benign and malignant patterns in melanocytic lesions.AimTo determine if there is a predominance of one dermoscopic pattern in patients with melanoma and if there is a significant difference in dominant global dermoscopic pattern in patients with cutaneous melanomas correlated with patients’ sex and the location of the primary tumor.Material and methodsThe study included 162 patients with prior diagnosis of cutaneous melanoma. Dermoscopic and videodermoscopic pictures and patient data were analyzed with regard to the pattern: reticular, globular, homogeneous and mixed pattern (two-component pattern; reticular-globular pattern) with central or peripheral globules and multicomponent (mixed – at least 3 types of structures in one nevus).ResultsThe reticular pattern was significantly more prevalent in male patients (38.57%, 27 patients) in comparison to female patients (18.45%, 17 patients). We also found a statistically significant lower prevalence of reticular pattern in patients diagnosed with melanomas located on upper limbs. The homogeneous pattern was statistically significantly more prevalent in patients in whom primary tumors were located on the head and upper limbs.ConclusionsOur study suggests that predominant complex patterns are more commonly observed in patients diagnosed with cutaneous melanoma, although there is a significant number of patients with predominant reticular and homogeneous patterns, which are not often associated with an increased risk of development of melanoma.

Enlarging melanocytic lesions with peripheral globular pattern: a dermoscopic and confocal microscopy study.

Enlarging melanocytic lesions with peripheral globular pattern (EMLPGP) are a pitfall in dermoscopy. Our aim was to evaluate the meaning of EMLPGP and to assess the use of dermoscopy and reflectance confocal microscopy (RCM) in order to improve the clinical management of this subtype of melanocytic lesions. A total of 135 EMLPGP were recruited and, accordingly to the dermoscopy features, were removed; later, an expert dermoscopist reviewed the lesions blinded to histology. Moreover, a subgroup of 63 lesions who underwent also to RCM, were reviewed by an expert confocalist. Patients had a median age of 41 years old and a female prevalence (61.5%). The main anatomic site was the trunk (86%). Histology of the 135 excised EMLPGP disclosed 116 nevi (86%; P<0.0001) and 19 melanomas (14%). On dermoscopy, statistical significance was detected for small globules that were observed in 106 cases (78.5%; P<0.0001), while globules distribution and color did not impact the diagnosis prediction, as well as age, sex or any other patient profile. Considering the RCM, atypical cytology and irregular architecture were detected in 100% of melanomas (P<0.0001). Our study shows that EMLPGPs are detectable in every age and can be a pitfall in especially in high risk patients with an over-excision of lesions. The presence of peripheral globules should be evaluated considering the overall dermoscopic features. RCM can contribute significantly in the management of lesions trough the detection of cyto-architectural atypia. Therefore, RCM in combination with dermoscopy can optimize the reduction of harmless lesions.

Dermoscopy of naevi in patients with oculocutaneous albinism.

Oculocutaneous albinism (OCA) increases predisposition to skin malignancies. Nevertheless, the differential diagnosis between melanoma and naevi in patients with OCA is still challenging, because pigmentary lesions have rarely been described in this population. We aimed to describe the dermoscopic patterns of naevi in patients with OCA. We prospectively evaluated 83 naevi from 37 patients with OCA in a single centre in Brazil. Lesions were analysed by eye and by dermoscopy and were grouped by dermoscopic pattern. Eight main patterns were identified: homogeneous structureless pattern (n = 28; 33.7%), globular pattern (n = 27; 32.5%), reticular pattern (n = 8; 9.6%), peripheral reticular pattern with central hypopigmentation (n = 8; 9.6%), peripheral globules (n = 8; 9.6%), irregular brown globules with pink background (n = 2; 2.4%), reticular globular disorganized pattern (n = 1; 1.2%) and peripheral reticular globular with central hypopigmentation (n = 1; 1.2%). We found previously undescribed dermoscopic patterns in patients with OCA, in addition to confirming previously described patterns. These descriptions may help the understanding of pigmented naevi in patients with OCA.

Dermoscopic evaluation of melanocytic nevi changes after photo-epilation techniques: a prospective study.

The clinical and dermoscopic changes of melanocytic nevi under the effects of photo-epilation are poorly known. Prospective study on clinical and dermatoscopic effects of photoe-pilation on melanocytic nevi. Eighteen patients exposed to photo-epilation gave consent to a follow-up programme from 2008 to 2017 at the Videodermatoscopic Office of the Dermatology Clinic of Cagliari (Italy), with clinical and dermoscopic assessment. A mean 2-year follow-up was recorded for 73 lesions. The most frequent clinical change was nevi colour, clearer than basal pictures, sometimes with increased pigmentation at the periphery, or residual islands of pigmentation, with vanishing borders. Acute burn with crusting was noted in few cases. Only one case showed progressive growth. Corresponding dermoscopic findings were bleaching of nevi, followed by pigment network disruption, appearance of white structureless areas and grey-blue globules. Complete regression occurred in 32.8% of the lesions. The growing nevus was characterized by peripheral globules. Excision for histopathological examination showed a compound nevus with mild atypia. Although malignant modifications of nevi after photo-epilation have not been described, the clinical and dermoscopic changes we observed suggest to extend the follow for more than 24months, as the potential long-term adverse effects of photo-epilation on melanocytic nevi are unknown.

PO325 Primary Hypotension is Mainly Women's Diseases：Study on Regularity of Clinical and Ambulatory Blood Pressure Patterns in 279 Random Cases

The morphology and biology of nevi with peripheral globules are well known, whereas those of melanomas with peripheral globules remain unclear.Comparing the dermatoscopic characteristics of nevi and melanomas with peripheral globules.A total of 401 melanocytic lesions with peripheral globules were included in this retrospective study. Dermatoscopic patterns and structures, including those of peripheral globules, were evaluated. A generalized estimating equation model with a binomial distribution dependent variable and logit link function was fitted to the dataset to identify features with the highest odds of differentiating melanoma from nevi.Of the 401 lesions, 179 (44.64%) were excised, 41 (10.22%) of which were melanomas. Melanomas were most common in the lower extremities (P < .01), with a disorganized pattern, whereas melanocytic nevi were most common on the trunk, with an organized pattern. In addition, the presence of blotches, atypical dots and globules, or atypical vessels was associated with melanomas (P < .01).The retrospective design of the study may have caused an inclusion bias.Melanocytic lesions displaying peripheral globules are at the greatest risk of melanoma if located on the lower extremity and if lesions reveal any of the following structures: blotch, atypical dots and globules, or atypical vessels.

Mélanome en thèques

Nested melanoma in elderly subjects is an entity that has been reported in the literatureonly since 2012. In this paper, we describe its distinctive clinical, dermatoscopic and histopathological features and compare them to previous published cases, with the aim of highlightingcertain specific criteria of this melanoma subtype. A 52-year-old man was referred for the presence on his chest of a large suspicious pigmented lesion of irregular shape and colour. Dermatoscopically, the lesion was chaotic and characterized by a black, structureless, eccentric area with some peripheral globules as well as some segmental radial lines. Histopathological examination revealed the presence of an asymmetric lesion with large junctional melanocytic nests showing a focal tendency to gathering and some cytological atypia. A diagnosis of nested melanoma was ultimately made. Nested melanoma of the elderly represents a distinct anatomoclinical variant of superficial spreading melanoma. Clinically, the lesion is usually large and occurs in photodamaged skin. We would stress that the "elderly" criterion is not mandatory given the numerous cases reported in people under 60 years. The main dermatoscopic feature is a globular pattern, but several features characteristic of superficial spreading melanoma may also be present. Histological diagnosis may be difficult because of the mainly nested pattern, and the condition may be confused histologically with a benign junctional nevus. But these large junctional nests of different sizes, with bridging and cytonuclear atypias, together with asymmetry of the lesions are the hallmark of this special kind of melanoma.

Growth-Curve Modeling of Nevi With a Peripheral Globular Pattern.

Although nevi with a peripheral rim of globules (peripheral globular nevi [PGN]) observed with dermoscopy are associated with enlarging melanocytic nevi, their actual growth dynamics remain unknown. Because change is a sensitive but nonspecific marker for melanoma, beginning to understand the growth patterns of nevi may improve the ability of physicians to differentiate normal from abnormal growth and reduce unnecessary biopsies. To study the growth dynamics and morphologic evolution of PGN on dermoscopy. A total of 84 participants with 121 PGN from September 1, 1999, through May 1, 2013, were identified retrospectively. Cohorts were recruited from the Memorial Sloan Kettering Cancer Center; Melanoma Unit of the Hospital Clinic, University of Barcelona; and Study of Nevi in Children. All 3 cohorts underwent longitudinal monitoring with serial dermoscopic imaging of their PGN. Data analysis was performed from May 1, 2014, through April 1, 2015. Establishment of the natural growth curve of PGN. The secondary aim was to establish the median time to growth cessation in those PGN for which the size eventually stabilized and/or had begun to decrease during the study period. The median duration of follow-up was 25.1 (range, 2.0-114.4) months. Most of the nevi (116 [95.9%]) enlarged at some point during sequential monitoring. The rate of increase in the surface area of PGN varied among cohorts and ranged from -0.47 to 2.26 mm2/mo (mean rate, 0.25 [95% CI, 0.14-0.36] mm2/mo). The median time to growth cessation in the 26 PGN that stabilized or decreased in size (21.5%) was 58.6 months. All lesions changed in a symmetric manner and 91 (75.2%) displayed a decrease in the density of peripheral globules over time. Nevi displaying a peripheral globular pattern enlarged symmetrically with apparent growth cessation occurring during a span of 4 to 5 years. Our results reiterate the important concept that not all growth is associated with malignancy.

Association between genetic factors, naevus count and dermoscopic pattern.

ORIGINAL ARTICLE, p 1081 It is well known that naevogenesis is a complex process that has its critical periods in childhood and adolescence.1 Moreover, the development of naevi is influenced not only by age but also by factors such as sex, sun exposure, skin type and freckling, to name just a few.2 A growing body of evidence has suggested that naevi have a strong heritable component in which gene variants implicated in naevus development include those involved in pigmentation, cell cycle regulation, telomere function and senescence. A deep understanding of the dynamic process of naevogenesis has been offered by dermoscopy and in vivo confocal microscopy. These methods have provided new insights into the growing pattern of some naevi (lesions with peripheral globules) and the stability of other naevi typified by a reticular pattern, suggesting that dermoscopically defined subsets of acquired naevi are biologically distinct.1 3 The study by Orlow et al.4, in this issue of the BJD, evaluates the potential associations between genetics and both melanocytic naevus count and dermoscopic naevus patterns in early life.

Cutaneous Metastatic Breast Carcinoma with Melanocyte Colonization: A Clinical and Dermoscopic Mimic of Malignant Melanoma

Melanocyte colonization of breast carcinoma cells may occur in those tumors that breach the epidermal-dermal interface. The resultant melanin deposition in tumor cells rarely leads to clinical pigmentation of the tumor. Typically, selective staining methods are required to detect the pigment. The authors describe a 60-year-old woman with a history of mammary carcinoma and an irregularly pigmented nodule with peripheral globules and a blue-white veil on dermoscopy, which was a clinical and dermoscopic mimic of malignant melanoma. Awareness of melanocyte colonization of non-melanocytic tumor cells and the dermoscopic-histologic correlations can aid in avoiding a potential pitfall, and emphasize the importance of such relationships, when using this tool.

Cutaneous Metastatic Breast Carcinoma with Melanocyte Colonization

BACKGROUND Melanocyte colonization of breast carcinoma cells may occur in those tumors that breach the epidermal—dermal interface. The resultant melanin deposition in tumor cells rarely leads to clinical pigmentation of the tumor. Typically, selective staining methods are required to detect the pigment. OBSERVATION The authors describe a 60-year-old woman with a history of mammary carcinoma and an irregularly pigmented nodule with peripheral globules and a blue-white veil on dermoscopy, which was a clinical and dermoscopic mimic of malignant melanoma. CONCLUSIONS Awareness of melanocyte colonization of non-melanocytic tumor cells and the dermoscopic—histologic correlations can aid in avoiding a potential pitfall, and emphasize the importance of such relationships, when using this tool.