Melanoma in skin of color

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 Author(s): Richard Usatine, Rachel Manci

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Description	This chapter describes the dermoscopy criteria of melanoma in skin of color
Author(s)	Rachel Manci · Richard Usatine
Responsible author	Richard Usatine → send e-mail
Status	unknown
Status update	April 19, 2023
Status by	Ralph P. Braun

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Melanoma occurs less frequently in persons of color but is associated with higher rates of morbidity and mortality. In a systematic review performed by Higgins et al., the following conclusions were made:

• African Americans have deeper tumors at time of diagnosis in addition to increased rates of regionally advanced and distant disease. Lesions are generally located on the lower extremities and have an increased propensity for ulceration. Acral lentiginous melanoma (ALM) is the most common melanoma subtype found in AA patients.
• In Hispanics, superficial spreading melanoma is the most common melanoma subtype. Lower extremity lesions are more common relative to Caucasians. Hispanics have the highest rate of oral cavity melanomas across all ethnic groups.
• In Asians, acral and subungual sites are most common. Specifically, Pacific Islanders have the highest proportion of mucosal melanomas across all ethnic groups.

Local dermoscopic features described for melanoma in general (mostly studied in light skinned populations) are the following:

Melanoma specific structures:

Melanoma patterns:

Current literature on melanoma in SOC:

December 2020, Pubmed search of dermoscopy melanoma “skin of color” comes up with 2 references only: Tan A, Stein JA. Dermoscopic patterns of acral melanocytic lesions in skin of color. Cutis. 2019 May;103(5):274-276.

Madankumar R, et al. Acral melanocytic lesions in the United States: Prevalence, awareness, and dermoscopic patterns in skin-of-color and non-Hispanic white patients. J Am Acad Dermatol. 2016 Apr;74(4):724-30.e1. doi: 10.1016/j.jaad.2015.11.035. Epub 2016 Jan 20. PMID: 26803347.

(Note that none of the lesions were melanomas)

A similar search on “dermoscopy melanoma African” added this article: de Giorgi V, Trez E, Salvini C, Duquia R, De Villa D, Sestini S, Gervini R, Lotti T. Dermoscopy in black people. Br J Dermatol. 2006 Oct;155(4):695-9. doi: 10.1111/j.1365-2133.2006.07415.x. Performed in Brazil, 100 clinically suspicious cases, 79 were Clark naevi, 15 seborrhoeic keratoses, four blue naevi, one dermatofibroma and one melanoma. Darker pigmentation of the skin did not impede the identification of single dermoscopic features. With only one melanoma, it is hard to draw conclusions about sensitivity of the features described originally in lighter skin.

A similar search on “dermoscopy melanoma Asian” found 13 articles including some relating to Hispanic skin. Most of these articles dealt with ALM. The Asian population is clearly the most studied group among all types of skin of color for dermoscopy of melanoma. We will address the details under the ALM section.

Superficial Spreading Melanoma

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  41-year-old Hispanic woman with a large superficial spreading melanoma on her abdomen. Depth 0.85 mm.

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  Shiny white lines, blue white veil, atypical globules.

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  63-year-old Hispanic woman with large advanced melanoma arising in the nevus on the right shoulder. Depth of 5.5 mm and positive sentinel node biopsy.

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  Dermoscopy shows satellitosis, blue white veil, shiny white lines.

Nodular Melanoma

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  Nodular melanoma that is mostly hypomelanotic with 1.5 mm depth on the back of a 29-year-old Hispanic woman.

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  Note the atypical vessels including a serpentine vessel.

 

Lentigo Maligna Melanoma

While LMM can occur on the face and other sun-damaged areas.

Face

• Annular-granular pattern
• Asymmetric follicular openings
• Gray dots/granules around ostial openings
• Circle within circle sign
• Angulated lines forming rhomboids
• Blotches

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  Lentigo maligna melanoma on the forehead of a 70-year-old Hispanic man.

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  Note the prominent circle within the circle pattern in the top right hand corner and the blotched out gland openings.

 

Acral lentiginous melanoma (ALM)

Many articles in the medical literature state that acral lentiginous melanoma (ALM) is the most common type of melanoma in Asians and persons of African descent.

Data from the US Surveillance, Epidemiology, and End Results (SEER) registry from 2006 to 20152 showed % of ALM by ethnic group as:

• Black Americans (blacks) -34%
• Asian/Pacific Islanders -23%
• Hispanic whites – 9%
• Non-Hispanic whites – 1%.

Studies outside the US have shown percentage of ALM amongst all melanoma cases by ethnic groups:

• Asian – ALMs made up 65% of all melanomas
• Mexico – ALMs made up 24-31% of all melanomas

Acral Volar patterns: melanomas on the palms and soles

• Parallel ridge pattern
• Atypical fibrillar pattern
• Diffuse pigmentation with multiple shades of brown
• Multi-component pattern

In general, it is clear that ALM is a major cause of morbidity and mortality in skin of color patients. Therefore, the dermoscopy of these melanomas needs to be clearly understood and clinically applied.

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  Acral lentiginous melanoma on the heel of a 65 yo Hispanic woman.

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  Note the parallel ridge pattern.

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  Acral lentiginous melanoma in situ on the foot of a 63-year-old Hispanic man.

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  Note the multicomponent and parallel ridge patterns.

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  Acral lentiginous melanoma in man of African descent.

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  Note the parallel ridge pattern and ulceration.

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  Acral lentiginous melanoma in man of African descent.

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  Note the parallel ridge pattern.

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  Acral lentiginous melanoma in situ in a 51-year-old Chinese woman.

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  Note the parallel ridge pattern.

Other specific melanoma locations of interest are covered in the next subchapters.

• Nails in Skin of Color
• Mucosa in Skin of Color

Links to additional chapters on Skin of Color

• Dermoscopy of Skin of Color