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A Journal on Dermatology and Sexually Transmitted Diseases

Official Journal of the Italian Society of Dermatology and Sexually Transmitted Diseases
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Giornale Italiano di Dermatologia e Venereologia 2018 Jan 24

DOI: 10.23736/S0392-0488.18.05863-7


language: English

Reflectance confocal microscopy features of thin versus thick melanomas

Agnieszka KARDYNAL 1, Małgorzata OLSZEWSKA 2, Nathalie de CARVALHO 3, Irena WALECKA 1, Giovanni PELLACANI 3, Lidia RUDNICKA 2

1 Department of Dermatology, CSK MSWiA, Warsaw, Poland; 2 Department of Dermatology, Medical University of Warsaw, Warsaw, Poland; 3 Department of Dermatology, University of Modena and Reggio Emilia, Modena, Italy


BACKGROUND: In vivo reflectance confocal microscopy (RCM) plays an increasingly important role in differential diagnosis of melanoma. The aim of the study was to assess typical confocal features of thin (≤1mm according to Breslow index) versus thick (>1mm) melanomas.
METHODS: 30 patients with histopathologically confirmed cutaneous melanoma were included in the study. Reflectance confocal microscopy was performed with Vivascope equipment prior to excision. Fifteen melanomas were thin (Breslow thickness ≤ 1mm) and 15 were thick melanomas (Breslow thickness >1mm).
RESULTS: In the RCM examination, the following features were more frequently observed in thin compared to thick melanomas: edged papillae (26.7% vs 0%, p=0.032) and areas with honeycomb or cobblestone pattern (33.3% vs 6.7%, p=0.068). Both features are present in benign melanocytic lesions, so in melanoma are good prognostic factors. The group of thick melanomas compared to the group of thin melanomas in the RCM images presented with greater frequency of roundish cells (100% vs 40%, p=0.001), non-edged papillae (100% vs 60%, p=0.006), numerous pagetoid cells (73.3% vs 33.3%, p=0.028), numerous atypical cells at dermal-epidermal junction (53.3% vs 20%, p=0.058) and epidermal disarray (93.3% vs 66.7%, p=0.068).
CONCLUSIONS: Non-invasive imaging methods helps in deepening of knowledge about the evolution and biology of melanoma. The most characteristic features for thin melanomas in confocal examination are: fragments of cobblestone or honeycomb pattern and edged papillae (as good prognostic factors). The features of thick melanomas in RCM examination are: roundish cells, non-edged papillae, numerous pagetoid cells at dermal-epidermal junction and epidermal disarray.

KEY WORDS: Thin melanoma - Thick melanoma - Diagnostics - Reflectance confocal microscopy (RCM)

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Publication History

Article first published online: January 24, 2018
Manuscript accepted: January 11, 2018
Manuscript received: November 21, 2017

Cite this article as

Kardynal A, Olszewska M, De Carvalho N, Walecka I, Pellacani G, Rudnicka L. Reflectance confocal microscopy features of thin versus thick melanomas. G Ital Dermatol Venereol 2018 Jan 24. DOI: 10.23736/S0392-0488.18.05863-7

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