Original article
Clinical and dermoscopic characteristics of melanomas on nonfacial chronically sun-damaged skin

https://doi.org/10.1016/j.jaad.2015.02.1117Get rights and content

Background

Melanomas on chronically sun-damaged skin (CSDS) can be difficult to identify and often manifest morphologic features that overlap with benign lesions.

Objective

We describe and analyze the clinical and dermoscopic characteristics of melanomas on nonfacial CSDS.

Methods

Melanoma cases on nonfacial CSDS were retrospectively identified from the biopsy specimen logs of 6 melanoma clinics. Clinical and dermoscopic images were combined into 1 database. Demographics, clinical, dermoscopic, and histopathologic information were analyzed. Descriptive frequencies were calculated.

Results

One hundred eighty-six cases met the inclusion criteria: 142 melanomas in situ (76%) and 39 invasive (21%; mean thickness, 0.49 mm). Lentigo maligna was the most common histopathologic subtype (n = 76; 40.9%). The most frequent dermoscopic structures were granularity (n = 126; 67.7%) and angulated lines (n = 82; 44%). Vascular structures were more frequent in invasive melanomas (56% vs 12% of in situ melanomas). Most manifested 1 of 3 dermoscopic patterns: patchy peripheral pigmented islands, angulated lines, and tan structureless with granularity pattern.

Limitations

This was a retrospective study, and evaluators were not blinded to the diagnosis. In addition, interobserver concordance and sensitivity and specificity for dermoscopic structures were not evaluated.

Conclusion

Outlier lesions manifesting dermoscopic structures, such as granularity, angulated lines, or vessels and any of the 3 described dermoscopic patterns should raise suspicion for melanoma.

Section snippets

Methods

Cases of melanomas on nonfacial CSDS skin were retrospectively identified from the biopsy specimen log and image database of 6 dermatology and primary care skin cancer clinics (Memorial Sloan-Kettering Cancer Center, New York, NY; Skin and Cancer Associates, Plantation, FL; Melanoma Signature Skin Cancer Centre, Brisbane, Australia; Northern Rivers Skin Cancer Clinic, Ballina, Australia; Beenleigh Family Practice, Brisbane, Australia; and Hermit Park Clinic and Skin Cancer Care, Townsville,

Results

Of 186 cases that met the inclusion criteria, 112 (60%) patients were male and 62 (33%) were female. The average patient age was 68.5 years (range, 37-93 years). There were 142 (76.3%) in situ and 39 (21%) invasive melanomas (average thickness, 0.49 mm [range, 0.12-1.6 mm]). LM was the most common histopathologic subtype (n = 76; 40.9%), followed by superficial spreading melanoma (SSM; n = 42; 22.6%). Twenty-one cases (11.3%) revealed a combination of 2 subtypes of melanoma (Table I).

Lesions

Discussion

Melanomas occurring on nonfacial CSDS can be challenging to detect because they can mimic lentigines or nevi and be camouflaged amongst many surrounding benign lesions. Careful clinical examination together with dermoscopy can assist in the evaluation of these patients. There have been few studies examining these lesions.5, 6

Traditional melanoma classification is based on clinical and pathologic characteristics and includes 4 melanoma subtypes: SSM, LM, nodular melanoma, and acral lentiginous

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Funding sources: None.

Conflicts of interest: None declared.

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