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Methods to Differentiate Nevi from Melanoma
Published in Ashfaq A Marghoob, Ralph Braun, Natalia Jaimes, Atlas of Dermoscopy, 2023
Gabriella Brancaccio, Teresa Russo, Elvira Moscarella, Giuseppe Argenziano
Nodular melanoma may lack the classic ABCD criteria and may mimic benign tumors, including dermal nevi, vascular lesions, dermatofibromas, or seborrheic keratosis. Even the classic dermoscopic criteria of melanoma may be missing, since most of the criteria are based on features observed in superficial spreading melanoma with melanin/melanocytes located primarily in the epidermis or at the dermo-epidermal junction [14–16]. Clues to help detect nodular melanoma include the presence of blue and black color within the lesion [16], presence of milky-red areas, polymorphous vascular pattern, or the presence of shiny white lines. The presence of polymorphous vascular pattern and the presence of shiny white lines are especially important criteria for nodular melanomas lacking significant pigmentation [17,18]. In addition, so as not to miss a melanoma, any nodular lesion that does not display diagnostic dermoscopic features associated with a benign diagnosis (e.g. DF, intradermal melanocytic nevus (IDN), angioma) should be viewed with suspicion even if it lacks blue-black color, vessels, or shiny white structures. (Figures 9c.7, 9c.8). We would like to underscore that nodular lesions should never, ever be subjected to short-term monitoring, since a delay in the treatment of nodular melanoma of as little as a few months can negatively impact prognosis. Thus, in the case of atypical nodular lesions, the best strategy is “if in doubt, cut it out!”
Non-erythematous lesions
Published in Richard Ashton, Barbara Leppard, Differential Diagnosis in Dermatology, 2021
Richard Ashton, Barbara Leppard
Nodular malignant melanoma. This type needs to be distinguished from the superficial spreading melanoma. Here, there is no radial growth and the malignant melanocytes grow down vertically from the start. The lesion is a nodule without any surrounding irregular pigmentation. A typical nodular melanoma is a black dome shaped nodule. The surface of the lesion will eventually break down to bleed, ooze and crust over. Sometimes nodules may be red (amelanotic–see also Fig. 8.18, p. 147) rather than brown-black. The diagnosis can be delayed as there is no superficial spread to alert the patient, and prognosis is often poor as the lesion will be relatively thick before it has been diagnosed and removed. Black or red nodules should be referred for biopsy.
Melanomas
Published in E. George Elias, CRC Handbook of Surgical Oncology, 2020
The T classification takes into consideration Clark’s and Breslow’s descriptions of the level of invasion and the thickness of the tumor at the primary site.21,22 This has replaced an old classification,23 which describes the primary lesion on the basis of clinical findings which included: Lentigo maligna, which occurs in elderly people on sun exposed areas after a long period of 10 to 20 years developing in an underlying Hutchinson’s freckle.Superficial spreading melanoma, which occurs in middle age, more commonly in women. This also has a long period of antecedent lateral superficial growth. The prognosis is less favorable than lentigo maligna, but better than the third type which is nodular melanoma.Nodular melanoma, which is characterized by fast growth, more common in men, and carries a very guarded prognosis. These nodular melanomas can occur in combination with superficial spreading types, but the prognosis will relate to the nodular type rather than the superficial spreading melanoma.
Near-infrared photoimmunotherapy for the treatment of skin disorders
Published in Expert Opinion on Biological Therapy, 2022
Irene Russo, Laura Fagotto, Anna Colombo, Emma Sartor, Roberto Luisetto, Mauro Alaibac
The four major subtypes of invasive cutaneous melanoma are: superficial spreading melanoma (the most common), nodular melanoma, lentigo maligna melanoma, and acral lentiginous melanoma. Uncommon variants of melanoma include amelanotic, desmoplastic, and spitzoid melanoma [56–60]. Histologically, melanoma displays two growth phases: in the horizontal or radial growth phase, which is not identifiable in nodular melanomas, tumor cells are confined to the epidermis, while in the vertical growth-phase tumor cells infiltrate the dermis and can metastasize [57]. The thickness of the tumor (Breslow depth) measured on histological samples correlates with the prognosis and the likelihood of metastasis of an invasive melanoma in the vertical growth phase [61]. Risk for metastasis also increases with ulceration, microsatellites, high mitotic rate, lymphovascular invasion, and either absent or minimum tumor-infiltrating lymphocytes [57].
Improved skin lesions detection using color space and artificial intelligence techniques
Published in Journal of Dermatological Treatment, 2020
Sudhriti Sengupta, Neetu Mittal, Megha Modi
In this work, computer experiments have been performed on three test images. Two of them are of neurofibromatosis. Nodular melanoma image has been taken as the third image for testing. The entropy of all images obtained by the application of the proposed methodologies is compared. This comparison results in the determination of the most accurate and effective technique to identify and detect skin lesion. The result is summarized in Table 1. From the given results we can understand that Canny Edge Operator, when optimized with ACO, gives the best result. In the Test Image 1, the entropies of Optimized Canny edge technique with ACO, Optimized Sobel edge technique with ACO, Optimized Prewitt edge technique with ACO and Edge Smoothing-Color Space techniques are 1.9557, 0.80691, 0.7538 and 1.8959 respectively. For Image 2 the entropies of Optimized Canny edge technique with ACO, Optimized Sobel edge technique with ACO, Optimized Prewitt edge technique with ACO and Edge Smoothing-Color Space techniques are 3.3643, 0.62694, 0.4633 and 2.0122 respectively. Similarly, for Image 3, entropies are 1.9604, 1.04774, 1.0278 and 1.8622 for the different methods. From this, it can be observed that ACO optimized Canny Edge detection technique gives best results in comparison with other techniques. This technique shows remarkable improvement in entropy and visibility properties of all skin lesionimage (Figure 5).
The use of in vivo reflectance confocal microscopy for the diagnosis of melanoma
Published in Expert Review of Anticancer Therapy, 2019
Marina Agozzino, Elvira Moscarella, Graziella Babino, Stefano Caccavale, Vincenzo Piccolo, Giuseppe Argenziano
Nodular melanoma (NM) is the subtype of melanoma with the worst biological behavior. It has a rapid growth rate, a high metastatic potential, and a poor prognosis. It is often a dark or pink-red (if amelanotic), rapidly growing papule or nodule and, sometimes, can have a non-alarming clinical appearance [37]. The ABCD criteria are often of no help for NM diagnosis. Despite the introduction of dermoscopy, the recognition of NM remains a challenge, since its features may be similar to benign nodular lesions [38]. Dermoscopically, most tumors have a homogeneous, disorganized, pattern or a featureless pattern with atypical vessels. Pigmented NM might present a blue-black color, with globules, and blue-white veil [39].