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Dermatoscopic Morphology: Predicting Nodular Non-Melanoma Versus Melanoma

By: Nahae Kim, MPH
Posted: Wednesday, September 16, 2020

In the Journal of the European Academy of Dermatology and Venereology, Alexander J. Stratigos, MD, of the Andreas Sygros Hospital, Athens, Greece, and colleagues suggested three key dermatoscopic predictors of thin nodular melanoma: dotted vessels, white shiny streaks, and irregular blue structureless areas. In this multicentric collaborative study by the International Dermoscopy Society, these clinical predictors may provide clinicians with useful clues to differentiating between nodular melanomas from non-melanoma tumors with a nodular appearance. 

Lesions from 254 patients were categorized as follows: thin nodular melanoma tumors (69 lesions, ≤ 2mm Breslow thickness), thick nodular melanoma tumors (96 lesions, ≥ 2mm Breslow thickness), and non-melanoma nodular lesions (89 total). The non-melanoma tumors included seborrheic keratosis, basal cell carcinoma, dermal nevi, squamous cell carcinoma, benign adnexal tumors, and angiomas.

Compared with non-melanomas, dotted vessels, shiny white streaks, and irregular blue structureless areas were associated with 3.4-fold, 2.9-fold, and 2.4-fold higher probability for thin nodular melanomas, respectively. Additional observations supported a light brown to blue color transition with increasing thickness of nodular melanoma tumors. Although nonpigmented thinner nodular melanomas had greater evidence of ulceration compared with pigmented lesions, the opposite was the case for thicker nodular melanomas. Furthermore, earlier diagnosis of nodular melanoma appears more problematic in the head/neck and acral skin regions, considering initial detection of lesions in these areas were often in their post-transformation, thicker stage.

The study authors emphasized the need for further evidence to support these initial findings and for a larger representative sample, as data used for this analysis were selectively filtered from tertiary centers. 

Disclosure: The study authors reported no conflicts of interest.

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