Epiluminescence microscopy: Criteria of cutaneous melanoma progression,☆☆

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Abstract

Background: Cutaneous melanoma develops through a series of evolutionary steps (intraepidermal, radial, and vertical growth phases) that are traceable in specific histologic features. Epiluminescence microscopy (ELM) is an in vivo technique that enables the visualization of morphologic structures in pigmented lesions correlated with specific histologic architectural characteristics. Many ELM criteria associated with cutaneous melanoma have been described, but their correlation with tumor progression has not yet been established. Objective: In this preliminary study our purpose was to explore the possibility of recognizing ELM criteria that allow the in vivo detection of the various phases of melanoma progression as well as tumor depth. Methods: Seventy-two cutaneous melanomas (41 “thin” melanomas [TnM], < 0.76 mm thickness, and 31 “thick” melanomas [TkM], > 0.75 mm thickness) were investigated with ELM for the presence of nine standard ELM criteria; their significance was determined by calculating the chi-square test of independence. Results: A significant association is found between the presence of pigment network and TnM and between the presence of gray-blue areas, vascular pattern, and TkM. Moreover, pigment network plus radial streaming is the most significant association of ELM criteria in TnM, whereas gray-blue areas plus vascular pattern is the greatest in TkM. Conclusion: This study shows a good correlation between certain ELM criteria and the histologic architecture of cutaneous melanoma for a preoperative evaluation of the tumor thickness. Further investigation is needed for verifying on a larger number of cases our pilot estimates of sensitivity and specificity of ELM criteria in thin and thick melanomas. (J Am Acad Dermatol 1997;37:68–74.)

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MATERIAL AND METHODS

A total of 72 patients whose ages ranged from 23 to 75 years (29 men and 43 women) affected by cutaneous melanoma were included in this study. Each lesion, after being covered by immersion oil and a glass slide (to render the stratum corneum translucent), was examined with a dermatoscope (Heine Delta 10, Optotechnik, Herrsching, Germany) and photographed with Dermaphot photo equipment (Heine Optotechnik) at a fixed magnification of × 10. In addition, 31 randomly selected cases were observed

RESULTS

The results are shown in Table II , where we report the frequency of occurrence of the standard ELM criteria (in Table II the vascular pattern is composed of two variables) in TnM and TkM.

TnMs are characterized by a higher frequency of occurrence of pigment network (95% TnM vs 68% TkM), radial streaming (83% TnM vs 71% TkM) and white scarlike areas (56% TnM vs 39% TkM).

In contrast, TkMs exhibit a greater frequency of occurrence of gray-blue areas (94% TkM vs 24% TnM), structural asymmetry (87%

DISCUSSION

Because evolutionary steps of melanoma are expressed by specific histologic patterns (Table VI) , 2 we have selected their correlated ELM criteria 3, 4, 12, 13, 14 (Table VII) . These criteria have been chosen to verify the hypothesis of the in vivo detection of the various phases of melanoma progression. On the basis of the ELM criteria incidence in TnM versus TkM, we have defined the first appearance of the different ELM features (Table VII) .

It is noteworthy that the ELM criteria mentioned

CONCLUSION

The analysis of the results of our pilot study shows a good correlation between the selected ELM criteria and the histologic architecture of the cultaneous melanoma, for a preoperative evalation of the tumor thickness. Pigment network and radial streaming indicate the radial growth phase of melanoma, whereas gray-blue areas and dotted vascular pattern (or the elongated loops) indicate the involvement of the mid and deep dermis and therefore the vertical growth phase of the tumor. The lower

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Reprint requests: Giuseppe Argenziano, MD, Clinica Dermatologica, Università “Federico II,” Via S. Pansini 5, 80131 Napoli, Italia.

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