RESUMO
BACKGROUND: The management of melanocytic lesions with peripheral globules (MLPGs) is usually age-dependent and can be challenging in high-risk melanoma patients. OBJECTIVES: 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. METHODS: 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. RESULTS: We enrolled 154 patients, mean age 42.45 years (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 6 mm 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. CONCLUSIONS: 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.
Assuntos
Melanoma , Neoplasias Cutâneas , Adulto , Dermoscopia , Diagnóstico Diferencial , Seguimentos , Humanos , Melanoma/diagnóstico por imagem , Microscopia Confocal , Estudos Prospectivos , Neoplasias Cutâneas/diagnóstico por imagemAssuntos
Anemia Diseritropoética Congênita/genética , Osso e Ossos/anormalidades , Unhas Malformadas/congênito , Anemia Diseritropoética Congênita/classificação , Anemia Diseritropoética Congênita/diagnóstico , Anemia Diseritropoética Congênita/patologia , Células da Medula Óssea/patologia , Osso e Ossos/patologia , Eritroblastos/patologia , Dedos/anormalidades , Dedos/patologia , Glicoproteínas/genética , Humanos , Lactente , Fatores de Transcrição Kruppel-Like/genética , Masculino , Proteínas Associadas aos Microtúbulos/genética , Mutação , Unhas/patologia , Unhas Malformadas/patologia , Proteínas Nucleares/genética , Sindactilia/genética , Proteínas de Transporte Vesicular/genéticaRESUMO
No disponible
Assuntos
Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Neoplasias/complicações , Neoplasias/diagnóstico , Neoplasias/patologia , Microscopia Confocal/instrumentação , Microscopia Confocal/métodos , Microscopia Confocal , Ceratose Seborreica/diagnóstico , Ceratose Seborreica/patologia , Ceratose Seborreica/cirurgia , Nevo Pigmentado/diagnóstico , Nevo Pigmentado/patologia , Nevo Pigmentado/cirurgia , Biópsia/instrumentação , Biópsia/métodos , Biópsia , Estudos RetrospectivosAssuntos
Ceratose Seborreica/patologia , Microscopia Confocal , Neoplasias Primárias Múltiplas/patologia , Nevo Pigmentado/patologia , Neoplasias Cutâneas/patologia , Feminino , Humanos , Ceratose Seborreica/complicações , Masculino , Pessoa de Meia-Idade , Neoplasias Primárias Múltiplas/complicações , Nevo Pigmentado/complicações , Neoplasias Cutâneas/complicaçõesAssuntos
Técnicas Cosméticas/efeitos adversos , Preenchedores Dérmicos/administração & dosagem , Escleroderma Sistêmico/induzido quimicamente , Silicones/efeitos adversos , Face , Feminino , Humanos , Injeções Intradérmicas , Pessoa de Meia-Idade , Procedimentos de Cirurgia Plástica/efeitos adversos , Silicones/administração & dosagemRESUMO
No disponible