Pigmented macules on the head and neck: A Systematic Review of dermoscopy features

Gracy Gouda; John  Pyne; Tony Dicker

doi:10.5826/dpc.1204a194

Pigmented macules on the head and neck

A Systematic Review of dermoscopy features

Authors

Gracy Gouda University of Queensland
John Pyne Faculty of Health Sciences, University of New South Wales, Sydney, Australia.
Tony Dicker Faculty of Medicine at the University of Queensland

Keywords:

epiluminescence microscopy,, dermoscopy, dermatoscopy, lentigo maligna, lentigo maligna melanoma, lichen-planus-like-keratosis, solar lentigo, seborrhoeic keratosis, pigmented actinic keratosis, pigmented Bowen’s disease, pigmented intraepidermal carcinoma, head and neck

Abstract

Introduction: Differentiating early melanoma from other flat pigmented lesions on the head and neck is challenging both clinically and dermoscopically, partly due to the wide differential diagnosis and the lack of specific diagnostic algorithms.

Objectives: To review publications covering the dermoscopic features of pigmented macules on the head and neck.

Methods: Embase and PubMed (Medline) database from Jan 2015 to Jan 2021 were searched using a four-step search. Keywords used were dermoscopy/dermatoscopy or epiluminescence microscopy, lentigo maligna (LM), lentigo maligna melanoma (LMM), lichen-planus-like-keratosis (LPLK), solar lentigo (SL), seborrhoeic keratosis (SK), pigmented actinic keratosis (PAK), pigmented Bowen’s disease (pBD), pigmented intraepidermal carcinoma (pIEC) and head and neck.

Results: The commonest reported dermoscopic features of facial melanoma were irregular dots, atypical dots/globules, asymmetric pigmented follicular openings (APFO), rhomboid grey/ black structures, increased vascular network, brown globules/dots and a pattern of circles. Pseudopods, radial streaming, blue white veil, irregular blotches, scar-like depigmentation and atypical pigment network were recorded in low frequencies. For PAK, pBD and pIEC perifollicular erythema, white/yellow surface scale, linear wavy vessels around hair follicles, hair follicular openings surrounded by a white halo, evident follicles or follicular or keratotic plugs, rosette sign and sharply demarcated borders were the salient features.

Conclusions: Further studies are needed to determine the dermoscopic criteria for pigmented melanocytic and non-melanocytic lesions on the head and neck. Furthermore, there is a gap in the knowledge of site-specific dermoscopic features on specific sites, namely ears, nose, cheeks, scalp and neck which will also benefit from further studies.

References

References:

Tschandl P, Rosendahl C, Kittler H. Dermatoscopy of flat pigmented facial lesions. Journal of the European Academy of Dermatology and Venereology. 2015;29(1):120-127.

Lallas A, Tschandl P, Kyrgidis A, et al. Dermoscopic clues to differentiate facial lentigo maligna from pigmented actinic keratosis. British Journal of Dermatology. 2016;174(5):1079-1085.

Juhász ML, Marmur ES. Reviewing challenges in the diagnosis and treatment of lentigo maligna and lentigo-maligna melanoma. Rare cancers and therapy. 2015;3(1):133-145.

Micantonio T, Neri L, Longo C, et al. A new dermoscopic algorithm for the differential diagnosis of facial lentigo maligna and pigmented actinic keratosis. European Journal of Dermatology. 2018;28(2):162-168.

Akay B, Kocyigit P, Heper A, Erdem C. Dermatoscopy of flat pigmented facial lesions: diagnostic challenge between pigmented actinic keratosis and lentigo maligna. British Journal of Dermatology. 2010;163(6):1212-1217.

Cameron A, Rosendahl C, Tschandl P, Riedl E, Kittler H. Dermatoscopy of pigmented Bowen's disease. Journal of the American Academy of Dermatology. 2010;62(4):597-604.

Barnes L. Surgical Pathology of the Head and Neck. vol 3. CRC Press; 2001.

Fadaki N, Li R, Parrett B, et al. Is head and neck melanoma different from trunk and extremity melanomas with respect to sentinel lymph node status and clinical outcome? Annals of surgical oncology. 2013;20(9):3089-3097.

Cengiz FP, Cengiz AB, Emiroglu N, Comert E, Wellenhof RH. Dermoscopic and clinical features of head and neck melanoma. Anais brasileiros de dermatologia. 2015;90(4):488-493.

Cohen LM. Lentigo maligna and lentigo maligna melanoma. Journal of the American Academy of Dermatology. 1995;33(6):923-936.

McKenna JK, Florell SR, Goldman GD, Bowen GM. Lentigo maligna/lentigo maligna melanoma: current state of diagnosis and treatment. Dermatologic surgery. 2006;32(4):493-504.

Bowen AR, Thacker BNP, Goldgar DE, Bowen GM. Immunohistochemical staining with Melan‐A of uninvolved sun‐damaged skin shows features characteristic of lentigo maligna. Dermatologic surgery. 2011;37(5):657-663.

Kittler H, Pehamberger H, Wolff K, Binder M. Diagnostic accuracy of dermoscopy. The lancet oncology. 2002;3(3):159-165.

Massone C, Di Stefani A, Soyer HP. Dermoscopy for skin cancer detection. Current opinion in oncology. 2005;17(2):147-153.

Megahed M, Schön M, Selimovic D, Schön MP. Reliability of diagnosis of melanoma in situ. The Lancet. 2002;359(9321):1921-1922.

Dika E, Lambertini M, Patrizi A, et al. Folliculotropism in head and neck lentigo maligna and lentigo maligna melanoma. JDDG: Journal der Deutschen Dermatologischen Gesellschaft. 2020;

Borsari S, Pampena R, Raucci M, et al. Neck Melanoma: Clinical, Dermoscopic and Confocal Features. Dermatology. 2020;236(3):241-247.

Braun R, Gaide O, Oliviero M, et al. The significance of multiple blue‐grey dots (granularity) for the dermoscopic diagnosis of melanoma. British Journal of Dermatology. 2007;157(5):907-913.

Guida S, Farnetani F, De Pace B, et al. Flat-pigmented facial lesions without highly specific melanocytic dermoscopy features: the role of dermoscopic globules and dots in differential diagnosis with corresponding reflectance confocal microscopy substrates. Journal of the European Academy of Dermatology and Venereology: JEADV. 2020;34(3):e153-e156.

Stolz W, Schiffner R, Burgdorf WH. Dermatoscopy for facial pigmented skin lesions. Clinics in dermatology. 2002;20(3):276-278.

Pralong P, Bathelier E, Dalle S, Poulalhon N, Debarbieux S, Thomas L. Dermoscopy of lentigo maligna melanoma: report of 125 cases. British Journal of Dermatology. 2012;167(2):280-287.

Tiodorovic-Zivkovic D, Zalaudek I, Lallas A, Stratigos AJ, Piana S, Argenziano G. The importance of gray color as a dermoscopic clue in facial pigmented lesion evaluation: a case report. Dermatology practical & conceptual. 2013;3(4):37.

Giacomel J, Lallas A, Argenziano G, Bombonato C, Zalaudek I. Dermoscopic “signature” pattern of pigmented and nonpigmented facial actinic keratoses. Journal of the American Academy of Dermatology. 2015;72(2):e57-e59.

Inskip M, Cameron A, Akay BN, et al. Dermatoscopic features of pigmented intraepidermal carcinoma on the head and neck. JDDG: Journal der Deutschen Dermatologischen Gesellschaft. 2020;18(9):969-976.

Li W, Zhang C. 180 The investigation of dermoscopy in differential diagnosis of facial actinic keratosis. Journal of Investigative Dermatology. 2017;137(5):S31.