Dermoscopic-pathologic correlation: an atlas of 15 cases

Gerardo Ferrara; Giuseppe Argenziano; H.Peter Soyer; Stefania Staibano; Eleonora Ruocco; Gaetano De Rosa

Dermoscopic-pathologic correlation: an atlas of 15 cases

Giuseppe Argenziano

2002, Clinics in Dermatology

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AI-generated Abstract

This article presents a comprehensive atlas of dermoscopic-pathologic correlations, analyzing 15 cases that illustrate both melanocytic neoplasms (MNs) and nonmelanocytic neoplasms (nMNs). It explains the importance of dermoscopy in diagnosing pigmented skin lesions and details a simplified protocol for conducting dermoscopic-pathologic correlation studies. The findings emphasize the strong relationship between dermoscopically identified features and their histopathological correlates, providing valuable insights for clinicians in improving diagnostic accuracy.

Figures (17)

Table 1. Histopathologic correlates of “local” dermoscopic features in melanocytic neoplasms Previous dermoscopic-pathologic studies®-® elucidated the histopathologic correlates of local dermoscopic fea- tures both in MNs (Table 1) and in nMNs (Table 2), thus helping refine their conceptual definitions as well as their practical applications. Terminology of local der-

Figure 1. (a) This pigmented skin lesion exhibits a typical reticular pattern revealing the basic dermoscopic criterion for establishing the melanocytic nature of a given pigmented lesion. Note the presence of a few black dots/globules regularly distributed at the center of the lesion, small and multifocal hypopigmented areas, and a faintly detectable grayish hue. Dermoscopically, this is a reticular type of Clark nevus. (b) Clark nevus. Pigmented and elongated rete ridges represent the histopathologic correlate of the pigment network seen by dermoscopy. The nonpigmented infundibulum of the hair follicle (arrow) corresponds to a circular hypopigmented area within the reticular pattern. The grayish hue is due to melanophages in the papillary dermis

Table 2. Histopathologic correlates of “local” dermoscopic features in nonmelanocytic neoplasms

Figure 2. (a) This pigmented skin lesion can be easily diagnosed as basal cell carcinoma owing to the presence of multiple blue-gray globules, ulceration (square), and spoke-wheel areas (circles). (b) Basal cell carcinoma, superficial type. Pigmented, solid aggregations of basaloid cells in the papillary dermis are the histopathologic counterpart of the multiple blue-gray globules dermoscopically stereotypical for this basal cell carcinoma. The scale-crust (oval) indicates the area of ulceration observed dermoscopically.

Figure 3. (a) This seborrheic keratosis can be diagnosed dermoscopically owing to the presence of multiple milialike cysts (circles) and numerous comedolike openings (squares). The latter ones display various shades from light brown to black. (b) Seborrheic keratosis. This acanthotic type of seborrheic keratosis is characterized by plugs filled with keratin (square) corresponding to comedolike openings and intraepidermal horn globules (circles) correlating to milialike cysts.

Figure 4. (a) Angiokeratoma dermoscopically characterized by multiple red to bluish-black lacunae. Note that the blue-whitish veil seen in this angiokeratoma has no diagnostic significance owing to the presence of red-blue lacunae and the absence of a pigment network. (Presented in part at the 2001 Annual Meeting of the Association for Research in Vision and Ophthalmology, Ft. Lauderdale, Florida). (b) Angiokeratoma. The few, rather large thrombosed vascular spaces correspond to the bluish-black lacunae. The hyperkeratosis and acanthosis, particularly seen at the edges of the lesion, reflect the histopathologic substrate of the blue-whitish veil.

Figure 5. (a) This dermatofibroma is characterized by a delicate pigment network at the periphery and a central white patch. It is particular because of the presence of brownish-yellow, partially confluent, globular structures resembling comedolike openings. (b) Dermatofibroma. Note the moderate epidermal hyperplasia with numerous keratin-filled plugs corresponding to the brownish-yellow globular structures seen by dermoscopy. A histopathologic correlate of the central white patch is not visible in this histopathologic sectio

Figure 6. (a) This particular type of Clark nevus, commonly seen in young adults, is dermoscopically characterized by a rim of globules at the periphery. (b) Clark nevus, compound type. The histopathologic counterpart of the brown globules in the periphery is the presence of round nests of melanocytes (circles) at the dermal-epidermal junction extending beyond the dermal component.

Figure 7. (a) This pigmented skin lesion shows the stereotypical dermoscopic appearance of a pigmented Spitz nevus (Reed nevus), which is characterized by the starburst pattern. Note the symmetric silhouette of the lesion, central hyperpigmentation (also called black lamella), and a rim of pigmented streaks regularly distributed at the periphery of the lesion. (b) Reed nevus. The diffuse, pigmented parakeratosis accounts for the black lamella, and the delicate, junctional nests of spindle-shaped melanocytes at the periphery (circle) correspond to the pigmented streaks.

Figure 8. (a) The homogenous steel-blue pigmentation without any local dermoscopic features is the hallmark of this blue nevus. (b) Blue nevus. This lesion is easily identified as a dermal proliferation of melanin-laden dendritic melanocytes interspersed among collagen fibers. The deep-sited pigmentation is responsible for the diffuse, bluish pigmentation seen by dermoscopy.

Figure 9. (a) This is a melanocytic lesion because of the presence of a particular type of globular pattern, also called cobblestone pattern. This is typified by the presence of large, somewhat angulated, brown to grayish globules. This pattern, together with the presence of hair follicles, is highly suggestive for the diagnosis of congenital melanocytic nevus. (b) Congenital melanocytic nevus. The caplike pigmentation of melanocytes in the superficial dermis correlates with the cobblestone pattern seen dermoscopically.

Figure 10. (a) Dermoscopically, the asymmetry of the pigmentation can be appreciated more clearly compared with the clinical image. Note the rhomboidal structures around hair follicles (square) suggestive of lentigo maligna. (b) Lentigo maligna. This melanoma in situ on severely sun-damaged skin (lentigo maligna) is characterized by an increased number of atypical melanocytes at the dermal-epidermal junction and above it. The rhomboidal structures correspond to a pronounced pigmentation at the “shoulders” of the infundibula as exhibited in the inset.

Figure 11. (a) This is a stereotypical image of acral nevus with pigmented lines following the sulci superficiales (parallel-furrow pattern). The acrosyringia are visible on the cristae superficiales as “strings of pearls.” (b) Acral melanocytic nevus. Nests of melanocytes are situated at the cristae limitantes with transepidermal melanin elimination (ovals) following the sulci superficiales.

Figure 12. (a) This labial lentigo is characterized by grayish-brown lines, some of which display a curvilinear pattern. (b) Labial lentigo. This tangentially cut labial lentigo has a pronounced pigmentation of the basal epidermis and a few melanophages in the lamina propria. Note that there is no increase of the number of melanocytes.

Figure 13. (a) This pink lesion reveals dermoscopically just a vascular pattern with numerous dotted and a few linear vessels. The reddish globules on the left side of the image are “artifacts” due to blood extravasation during local anesthesia. (b) Spitz nevus. Already at low magnification a striking feature of this compound type of Spitz nevus is the presence of numerous, small, telangiectatic vessels immediately beneath the epidermis, corresponding to the pronounced vascular pattern seen dermoscopically.

Figure 14. (a) The striking atypical pigment network renders the diagnosis of this superficial melanoma very easy. Note a white (scarlike) area in the center of the lesion intermingled with a few gray, pepperlike granules suggestive of regression. (b) Superficial melanoma with regression. In this section the regression, characterized by fibrosis and numerous melanophages in the papillary dermis, can be clearly appreciated.

Figure 15. (a) This nodular melanoma reveals a pronounced blue-whitish veil throughout the entire lesion, linear-irregular vessels, and a “hint” of an atypical pigment network at the right edge of the lesion. (b) Nodular melanoma. Beneath an atrophic epidermis there are sheets of striking atypical melanocytes.

Giuseppe Argenziano

The increasing use of dermoscopy in preoperative diagnosis of melanocytic skin neoplasms is impacting on routine histopathology to a relevant extent. We herein present the dermoscopic-pathologic features of 6 cases of histopathologically controversial melanocytic skin neoplasms. By illustrating these cases, we emphasize at least 3 different fields of interest for a combined (clinico-)dermoscopic-pathologic diagnostic approach, namely, information about the evolution of lesions; detection of gross sampling errors; definition of peculiar clinicopathologic entities. The theoretic and practical aspects of a close interaction among dermoscopists and histopathologists are itemized in detail. Semin Cutan Med Surg 28:157-164

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Dermoscopy pathology correlation in melanoma

Giuseppe Argenziano

Dermoscopy is a widely used technique whose role in the clinical (and preoperative) diagnosis of melanocytic and non-melanocytic skin lesions has been well established in recent years. The aim of this paper is to clarify the correlations between the "local" dermoscopic findings in melanoma and the underlying histology, in order to help clinicians in routine practice.

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When a clinical-dermoscopic correlation is warranted

Giuseppe Argenziano

A 64-year-old woman was seen because of the presence of a clinically suspicious, flat, pigmented lesion that had recently appeared on her left leg .

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Dermoscopy of pigmented skin lesions

Margaret Oliviero

Journal of the American Academy of Dermatology, 2005

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Dermoscopy of pigmented lesions of the mucosa and the mucocutaneous junction: results of a multicenter study by the International Dermoscopy Society (IDS)

Susana Puig

2011

To better characterize the dermoscopic patterns of mucosal lesions in relation to the histopathologic characteristics. Design: Retrospective and observational study. Setting: Fourteen referral pigmented lesion clinics in 10 countries. Patients: A total of 140 pigmented mucosal lesions (126 benign lesions, 11 melanomas, 2 Bowen disease lesions, and 1 metastasis) from 92 females (66%) and 48 males (34%) were collected from October 2007 through November 2008. Main Outcome Measures: Scoring the dermoscopic patterns (dots, globules, or clods, circles, lines, or structureless) and colors (brown, black, blue, gray, red, purple, and white) and correlation with the histopathologic characteristics. Results: Based on univariate analysis and 2 diagnostic models, the presence of structureless zones inside the lesions with blue, gray, or white color (the first model) had a 100% sensitivity for melanoma and 92.9% sensitivity for any malignant lesion, and 82.2% and 83.3% specificity for benign lesions in the group with melanoma lesions and the group with malignant lesions, respectively. Based on the colors (blue, gray, or white) only (the second model), the sensitivity for the group with melanoma was 100% and for the group with any malignant lesion was 92.9%, and the specificity was 64.3% and 65.1%, respectively. Patients with malignant lesions were significantly older than patients with benign lesions (mean [SD] ages, 60.1 [22.8] years vs 43.2 [17.3] years, respectively). Conclusion: The combination of blue, gray, or white color with structureless zones are the strongest indicators when differentiating between benign and malignant mucosal lesions in dermoscopy.

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Dermoscopic and histopathologic diagnosis of equivocal melanocytic skin lesions

Giuseppe Argenziano

Cancer, 2002

BACKGROUND. Dermoscopy (dermatoscopy, epiluminescence microscopy) is increasingly employed for the preoperative detection of cutaneous melanoma; dermoscopic features of pigmented skin lesions have been previously defined using histopathology as the key to the code. In a preliminary study on 10 cases evaluated by nine dermoscopists and nine histopathologists, the authors experienced that when at least two dermoscopists disagree in evaluating a melanocytic lesion, even histopathologic consultations may give equivocal results.

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Dermoscopy of pigmented skin lesions: Results of a consensus meeting via the Internet

Fezal Ozdemir

Journal of the American Academy of Dermatology, 2003

Background: There is a need for better standardization of the dermoscopic terminology in assessing pigmented skin lesions.

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Dermoscopic criteria and melanocytic lesions

Susana Puig

Giornale italiano di dermatologia e venereologia : organo ufficiale, Società italiana di dermatologia e sifilografia, 2012

Dermoscopy is a noninvasive, in vivo method for the early diagnosis of malignant melanoma and the differential diagnosis of pigmented lesions of the skin. By allowing visualization of sub-macroscopic pigmented structures that correlate with specific underlying histopathologic structures, dermoscopy provides a more powerful tool than the naked-eye examination for clinicians to determine the need to excise a lesion. This article reviews the principles of dermoscopy, the most common dermoscopic patterns associated with nevi and melanoma, and the factors influencing the nevus pattern in a given individual.

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Dermoscopy Key Points: Recommendations from the International Dermoscopy Society

A. Azenha, Andreas Blum, James Grichnik, J. Bandic, D. Langford, D. Polsky, Giuseppe Argenziano, Fezal Ozdemir

Dermatology, 2007

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Interobserver Agreement of the Dermoscopic Diagnosis of 129 Small Melanocytic Skin Lesions

M. Pizzichetta

Tumori Journal, 2002

Aim and background Dermoscopic diagnosis of pigmented skin lesions is based on the evaluation of dermoscopic criteria (classical pattern analysis) and on alternative diagnostic methods, such as the ABCD (A, asymmetry; B, border; C, color; D, differential structures) rule based on the total dermatoscopic score. The aim of the study was to investigate the interobserver agreement of standard dermoscopic criteria between two observers and the diagnostic validity of dermoscopic diagnosis by pattern analysis and by the ABCD rule. Study design The study included a total of 129 small (≤5 mm) melanocytic skin lesions selected from all lesions observed in consecutive patients between April 1996 and September 1998. Before surgery, each lesion was photographed with a Dermaphot. Dermoscopic images were examined independently by two observers to evaluate the presence or absence of standard dermoscopic criteria and to establish the dermoscopic diagnosis by pattern analysis and by the ABCD rule. Re...

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