Search

Objective: The objective was to describe the clinical and dermoscopic characteristics of difficult-to-diagnose melanomas (DDM)., Design: This study was a retrospective analysis of clinical data and dermoscopic images in a series of excised melanomas., Setting: Cases were obtained from the database registers of three public hospitals in Barcelona (Spain), Naples (Italy), and Graz (Austria)., Patients: A total of 97 tumors with a main preoperative diagnosis different from melanoma and without sufficient criteria to be diagnosed clinically and dermoscopically as melanoma were studied. We studied clinical data from the patients and lesions, mean reason for excision, and consensus dermoscopic description of the lesions according to pattern analysis performed by a panel of four dermoscopists to obtain clues that allow these melanomas to be recognized., Results: Ninety-three DDMs were evaluated. Three main dermoscopic categories of DDM have been identified: (1) DDMs lacking specific features (16/97), (2) DDMs simulating nonmelanocytic lesions (14/93), and (3) DDMs simulating benign melanocytic proliferations (67/93). The reasons for excision were (1) the subjective history of change referred by the patient (38% of cases), (2) the presence of clinical and/or dermoscopic "hints" for biopsy (33% of cases), and (3) the objective evidence of changes detected by digital dermoscopic follow-up (29% of cases)., Conclusions: A diagnostic algorithm is proposed not to miss melanoma.

Objective: To achieve a clinicopathologic classification of Spitz nevi by comparing their clinical, dermoscopic, and histopathologic features., Design: Eighty-three cases were independently reviewed by 3 histopathologists and preliminarily classified into classic or desmoplastic Spitz nevus (CDSN, n = 11), pigmented Spitz nevus (PSN, n = 14), Reed nevus (RN, n = 16), or atypical Spitz nevus (ASN, n = 14); the remaining 28 cases were then placed into an intermediate category (pigmented Spitz-Reed nevus, PSRN) because a unanimous diagnosis of either PSN or RN was not reached., Setting: University dermatology and pathology departments and general hospital pathology departments., Patients: A sample of subjects with excised melanocytic lesions., Main Outcome Measure: Frequency of dermoscopic patterns within the different histopathologic subtypes of Spitz nevi., Results: Overlapping clinical, dermoscopic, and histopathologic findings were observed among PSN, RN, and PSRN, thereby justifying their inclusion into the single PSRN diagnostic category. Asymmetry was the most frequent indicator of histopathologic ASN (79%; n = 11); in only 4 cases did dermoscopic asymmetry show no histopathologic counterpart, and in those cases the discrepancy was probably the result of an artifact of the gross sampling technique carried out with no attention to the dermoscopic features., Conclusions: Among Spitz nevi, histopathologic distinction between PSN and RN is difficult, not reproducible, and may be clinically useless. A simple clinicopathologic classification of these neoplasms might therefore be structured as CDSN, PSRN, and ASN. Asymmetry should be assessed using both dermoscopic and histopathologic analysis, and reliability in histopathologic diagnosis may be enhanced by the simultaneous evaluation of the corresponding dermoscopic images.