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Histopathologic Correlations of Dermoscopic Structures
Published in Ashfaq A Marghoob, Ralph Braun, Natalia Jaimes, Atlas of Dermoscopy, 2023
Daniel Morgado-Carrasco, Constanza Riquelme-Mc Loughlin, Ralph P. Braun, Oriol Yélamos
Streaks are linear pigmented projections located at the periphery of superficial spreading melanomas or Reed's nevi. They project from the tumor and radiate out towards normal skin. The term streaks encompasses radial streaming and pseudopods. Pseudopods correspond to linear projections that contain a bulbous terminal ending (Figures 3.16, 3.17, 3.18), and radial streaming corresponds to linear extensions without such a bulbous ending. Streaks are associated with the radial growth phase of Reed's nevi (Figure 3.19) and superficial spreading melanomas. Histologically, they correspond to linearly confluent junctional nests of pigmented melanocytes at the periphery of the lesion [43, 63]. Symmetrical distribution of streaks around the entire perimeter of a melanocytic lesion favors the diagnosis of a Reed's nevus. Streaks distributed asymmetrically or focally at the periphery favor the diagnosis of superficial spreading melanoma [18] (Figure 3.20).
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.
Cutaneous malignant melanoma: epidemiology, endocrine features and hormone replacement therapy
Published in A. R. Genazzani, Hormone Replacement Therapy and Cancer, 2020
Few data are currently available about hormone replacement therapy and melanoma40,44,66–72. In a population-based study in the San Francisco Bay area, factors related to menopause and use of exogenous hormones other than oral contraceptives were examined in 452 women with malignant melanoma and in 930 age-matched control women70. An increased risk was observed for superficial spreading melanoma in women who had natural menopause after 55 years (RR 3.6; 95% CI 1.1–11.1). A somewhat elevated risk of melanoma after menopause was no longer statistically significant after adjustment for exogenous hormone use. Conjugated estrogen use was associated with an increased RR for superficial spreading melanoma after hysterectomy with one ovary retained (RR 2.7; 95% CI 0.97–7.3) and after hysterectomy with bilateral oophorectomy (RR 2.1; 95% CI 0.86–5.0). However, the validity of this study has been questioned because sun exposure was not considered in the analysis and no clear duration-response relationship was detected71.
Improving the early diagnosis of early nodular melanoma: can we do better?
Published in Expert Review of Anticancer Therapy, 2018
Paola Corneli, Iris Zalaudek, Giovanni Magaton Rizzi, Nicola di Meo
RCM has contributed significant improvement in the early diagnosis of NMs. Some authors proposed a semi-quantitative algorithm for RCM evaluation of melanocytic lesions. They include: two major criteria, presence of non-edged papilla and cytologic atypia; four minor criteria, presence of roundish cells in the superficial layers, pagetoid cells widespread throughout the lesion, cerebriform clusters, and nucleated cells within the dermal papilla [40]. NM lacks some confocal features of the superficial spreading melanoma, such as epidermal disarrangement and pagetoid spreading. Massive proliferation in the dermis causes missing of the typical papillary architecture. Basal layer and upper dermis show pleomorphic cells with bright cytoplasm and dark nuclei, whereas amorphous, hyporefractive nest called ‘cerebriform nest’ are found in the deep dermis. This latter is a relevant criterion for the diagnosis of NM [20]. Other authors correlate dermoscopic BB feature with confocal features in NM [21]. Dermoscopic black color is associated with two different patterns: large black blotches and irregular black dots/globules. Black blotches result from the epidermis being totally filled by upward-migration melanocytes as nests and pagetoid cell, whereas black dots/globules correspond to the epidermis having spared areas between the upward-migrating nests and pagetoid cells. Black color results not only from epidermal melanin or hemoglobin (in case of ulceration), but also from a dense dermal proliferation of pigmented melanocytes under a significantly thinned, yet not ulcerated epidermis. Accordingly, black color may be even predictive of ulceration before it took place [26], which is a known, negative prognostic criterion. The dermoscopic criterion of short shiny white streaks appears to correlate dermal fibrosis or collagen bundles under RCM [20,41].
Development of a primary melanoma in situ within a full-thickness skin graft overlying a free muscle flap: a case report
Published in Case Reports in Plastic Surgery and Hand Surgery, 2018
Robert J. Dabek, Nemanja Baletic, Harrison McUmber, Brian Nahed, Alex Haynes, Kyle R. Eberlin, Branko Bojovic
Another case describes a man who suffered from compartment syndrome due to a right tibial plateau fracture requiring a 4-compartment fasciotomy with subsequent split-thickness skin grafting [9]. The skin graft was harvested from the ipsilateral thigh. A year and a half after this operation, he presented for dermatologic evaluation of pigmented lesions at both the recipient and donor sites. These lesions were then diagnosed as invasive superficial spreading melanoma.
Melanoma metastases occuring 40 years after primary melanoma
Published in Acta Oncologica, 2018
Gianni Gerlini, Lara Tripo, Serena Sestini, Paola Brandani, Vanni Giannotti, Riccardo Gattai, Lorenzo Borgognoni
Her clinical history revealed that she had a melanoma on the right leg that was surgically excised 40 years before. The histology report revealed a superficial spreading melanoma (Breslow thickness 0.5 mm and Clark level II). Since then she carried out regular follow-up, until she decided to stop 15 years ago. Clinical examination revealed the presence of three subcutaneous nodules located on the inner surface of the right limb (Figure 1).