Dermoscopic, Histological, Confocal Microscopy Correlation of Atypical-Dysplastic Melanocytic Nevi

Carmen Cantisani; Luca Ambrosio; Emanuele Annessi; Caterina Longo; Francesca Farnetani; Claudia  Pezzini; Alessandra  Condorelli; Giorgio Annessi; Luca Reggiani Bonetti; Stefania Guida; Carlo Cota; Antonella Tammaro; Camilla Chello; Giovanni Pellacani

doi:10.5826/dpc.1401a36

Dermoscopic, Histological, Confocal Microscopy Correlation of Atypical-Dysplastic Melanocytic Nevi

Authors

Carmen Cantisani Dermatology Unit, Department of Clinical Internal Anesthesiologic Cardiovascular Sciences, "Sapienza" University of Rome, Rome, Italy
Luca Ambrosio Dermatology Unit, Department of Clinical Internal Anesthesiologic Cardiovascular Sciences, "Sapienza" University of Rome, Rome, Italy
Emanuele Annessi Dermatology Unit, Department of Clinical Internal Anesthesiologic Cardiovascular Sciences, "Sapienza" University of Rome, Rome, Italy
Caterina Longo Dermatology Unit, University of Modena and Reggio Emilia, Modena, Italy
Francesca Farnetani Department of dermatology Modena and Reggio Emilia University
Claudia Pezzini Dermatology Unit, University of Modena and Reggio Emilia, Modena, Italy
Alessandra Condorelli Dermatology Unit, University of Modena and Reggio Emilia, Modena, Italy
Giorgio Annessi Dermatopathology Unit, Istituto Dermopatico dell’Immacolata, IRCCS, Roma, Italy
Luca Reggiani Bonetti Department of Diagnostic Clinic and Public Health Medicine University of Modena and Reggio Emilia, Italy
Stefania Guida School of medicine Vita Salute San Raffaele University, Dermatology Clinic, IRCS San Raffaele Hospital, Milan, Italy
Carlo Cota Genetic Research Molecular Biology and Dermopathology Unit San Gallicano Dermatology Unit, IRCCS, Rome Italy
Antonella Tammaro NESMOS Dermatology Department, Sapienza University of Rome, Rome, Italy
Camilla Chello Dermatology Unit, Department of Clinical Internal Anesthesiologic Cardiovascular Sciences, "Sapienza" University of Rome, Rome, Italy
Giovanni Pellacani Dermatology Unit, Department of Clinical Internal Anesthesiologic Cardiovascular Sciences, "Sapienza" University of Rome, Rome, Italy

Keywords:

atypical nevi, confocal microscopy, dermoscopy, dysplastic nevi, histopathology, melanoma

Abstract

Introduction: The term "atypical melanocytic nevus" (AMN) is used as a synonym for dysplastic nevus (DN) in clinical practice. Although the criteria for diagnosis of AMN/DN by the Agency for Research on Cancer helps to differentiate AMN/DN from common acquired nevi, they do not have high degrees of specificity, as they are similar to those used for the diagnosis of melanoma.

Objectives: In this retrospective study we evaluated the correlation and diagnostic concordance of dermoscopy, confocal microscopy, and histological examination in 50 AMN.

Methods: A graded scale was used to compare histological examination with dermoscopy and confocal microscopy. Low magnification histological images of only the central part of lesions were examined. This allowed histological diagnoses based almost exclusively on architectural criteria instead of simultaneously architectural and cytological, as in the global histological examination.

Results: Our data demonstrate that the diagnostic accuracy of dermoscopy and confocal microscopy diagnosis of the clinical aspects of AMN/DN as nevi or melanomas tends to be equivalent, being fair for nevi and excellent for melanomas. The total percentage of AMN suggested that the accuracy of confocal microscopy in the diagnosis of melanoma (86.7%) is greater than that of dermoscopy (73.3%).

Conclusions: This study demonstrated that diagnostic assessments of AMN/DN by dermoscopy and confocal microscopy are accurate and often coincide with those of histological examination and that their combined use helps to better manage and monitor these patients by facilitating early detection of melanomas and reducing unnecessary excisions of benign melanocytic lesions.

References

Elder DE, Massi D, Scolyer RA, Willemze R. WHO classification of skin tumor 4th ed. 2018.

Gandini S, Sera F, Cattaruzza MS, et al. Meta-analysis of risk factors for cutaneous melanoma: I. Common and atypical naevi. Eur J Cancer. 2005;41(1):28-44. DOI: 10.1016/j.ejca.2004.10.015. PMID: 15617989.

Elder DE. Dysplastic naevi: an update. Histopathology. 2010;56(1):112-120. DOI: 10.1111/j.1365-2559.2009.03450.x. PMID: 20055909.

Shors AR, Kim S, White E, et al. Dysplastic naevi with moderate to severe histological dysplasia: a risk factor for melanoma. Br J Dermatol. 2006;155(5):988-993. DOI: 10.1111/j.1365-2133.2006.07466.x. PMID: 17034530.

Xiong MY, Rabkin MS, Piepkorn MW, et al. Diameter of dysplastic nevi is a more robust biomarker of increased melanoma risk than degree of histologic dysplasia: a case-control study. J Am Acad Dermatol. 2014;71(6):1257-1258.e4. DOI: 10.1016/j.jaad.2014.07.030. PMID: 25454033.

Clemente C, Chocrane AJ, Eldwer DE, et al. Histopathologic diagnosis of dysplastic nevi: concordance among pathologists convened by the World Health Organization Melanoma Programme. Hum Pathol. 1991;22(4):313-319. DOI: 10.1016/0046-8177(91)90078-4. PMID: 1741810.

Weinstock MA, Barnhill RL, Rhodes AR, Brodsky GL. Reliability of the histopathologic diagnosis of melanocytic dysplasia. The Dysplastic Nevus Panel. Arch Dermatol. 1997;133(8):953-958. PMID: 9267239.

Ahmed I, Piepkorn MW, Rabkins MS, et al. Histopathologic characteristics of dysplastic nevi. Limited association of conventional histologic criteria with melanoma risk group. J Am Acad Dermatol. 1990;22(5 Pt 1):727-733. PMID: 2347959.

Rhodes AR, Mihm MC Jr., Weinstock MA. Dysplastic Melanocytic Nevi: a Reproducible Histologic Definition Emphasizing Cellular Morphology. Mod Pathol 2:306, 1989. Mod Pathol. 1990;3(1):99. PMID: 2308925.

Kelly JW, Crutcher WA, Sagebiel RW. Clinical diagnosis of dysplastic melanocytic nevi. A clinicopathologic correlation. J Am Acad Dermatol. 1986;14(6):1044-1052. DOI: 10.1016/s0190-9622(86)70131-x. PMID: 3722481.

Black WC, Hunt WC. Histologic correlations with the clinical diagnosis of dysplastic nevus. Am J Surg Pathol. 1990;14(1):44-52. DOI: 10.1097/00000478-199001000-00005. PMID: 2294780.

Barnhill RL, Roush GC. Correlation of clinical and histopathologic features in clinically atypical melanocytic nevi. Cancer. 1991;67(12):3157-3164. DOI: 10.1002/1097-0142(19910615)67:12<3157::aid-cncr2820671237>3.0.co;2-6. PMID: 2044059.

Annessi G, Cattaruzza MF, Abeni D, et al.. Correlation between clinical atypia and histologic dysplasia in acquired melanocytic nevi. J Am Acad Dermatol. 2001;45(1):77-85. DOI: 10.1067/mjd.2001.114580. PMID: 11423839.

Suh KS, Park JB, Kim JH, et al. Dysplastic nevus: Clinical features and usefulness of dermoscopy. J Dermatol. 2019;46(2):e76-e77. DOI: 10.1111/1346-8138.14583. PMID: 30079501.

Grichner JM. Dermoscopy of melanocytic neoplasms: subpatterns of dysplastic/atypical nevi. Arch Dermatol. 2003;139(9):1238. DOI: 10.1001/archderm.139.9.1238. PMID: 12975178.

Grichner JM. Dermoscopy of melanocytic neoplasms: subpatterns of dysplastic/atypical nevi. Arch Dermatol. 2003;139(7):970. DOI: 10.1001/archderm.139.7.970. PMID: 12873908.

Guitera P, Pellacani G, Longo C, Seidenari S, Avramidis M, Menzies SW. In vivo reflectance confocal microscopy enhances secondary evaluation of melanocytic lesions. J Invest Dermatol. 2009;129(1):131-138. DOI: 10.1038/jid.2008.193. PMID: 18633444.

Pellacani G, Farnetani F, Gonzalez S, et al. In vivo confocal microscopy for detection and grading of dysplastic nevi: a pilot study. J Am Acad Dermatol. 2012;66(3):e109-e121. DOI: 10.1016/j.jaad.2011.05.017. PMID: 21742408.

Maize JC, Ackerman AB. Pigmented lesions of the skin. Philadelphia: Lea & Fabiger, 1987.

Elder DE. Lever’s Histopathology of the skin. 9th Ed. Philadelphia:Lippincott Willams & Wilkins, 2005.

Yelamos O, Manubens E, Jain M, et al. Improvement of diagnostic confidence and management of equivocal skin lesions by integration of reflectance confocal microscopy in daily practice: Prospective study in 2 referral skin cancer centers. J Am Acad Dermatol. 2020;83(4):1057-1063. DOI: 10.1016/j.jaad.2019.05.101. PMID: 31202873. PMCID: PMC8285925.

Condorelli AG, Farnetani F, Ciardo S, et al. Dynamic dermoscopic and reflectance confocal microscopic changes of melanocytic lesions excised during follow up. J Am Acad Dermatol. 2022;86(5):1049-1057. DOI: 10.1016/j.jaad.2021.03.081. PMID: 33823198.

Muruzabal UF, Villegas RG, Franco AP, et al. Combined in vivo reflectance confocal microscopy and digital dermoscopy for follow up of patients at high risk of malignant melanoma: A prospective case series study. J Dermatol. 2017;44(6):681-689. DOI: 10.1111/1346-8138.13743. PMID: 28191661.

Argenziano G, Mordente I, Ferrara G, Sgambato A, Annese P, Zalaudek I. Dermoscopic monitoring of melanocytic skin lesions: clinical outcome and patient compliance vary according to follow-up protocols. Br J Dermatol. 2008;159(2):331-336. DOI: 10.1111/j.1365-2133.2008.08649.x. PMID: 18510663.