Melanoma on sun damaged skin

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 Authored by: Ralph P. Braun     ·  Natalia Jaimes

 Keywords:   sun damaged skin · skin · sun damage
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Description In this chapter we describe the different dermoscopyDermoscopy is a non invasive diagnostic method. pattern of melanomaThis glossary term has not yet been described. on sun damaged skinThis glossary term has not yet been described.
Author(s) Ralph P. Braun · Natalia Jaimes
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Status released
Status update May 29, 2017
Status by Ralph P. Braun
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Identifying melanomas located on chronically sun-damaged skin (CSDS) is challenging because their characteristics often clinically overlap with benignThis glossary term has not yet been described. lesions. DermoscopyDermoscopy is a non invasive diagnostic method. has proven useful in detecting and differentiating melanoma from many benign lesions, including solar lentigoThis glossary term has not yet been described. and seborrheic keratosisThis glossary term has not yet been described.. The dermoscopic attributes associated with melanoma on sun-damaged skin of the faceThis glossary term has not yet been described., primarily lentigo maligna are well described (see chapter). These descriptions may be dependent on the specific anatomic structure of the facial skin (ie, absence of rete ridgeThis glossary term has not yet been described. pattern and presence of pilosebaceous structures and hair follicles). The anatomy of sun damaged skin on other areas is different. This is characterized by atrophy of the epidemis and flattening of the dermoepidermal junction. This is the reason why melanoma on sun damaged skin looks different on non facial skinThis glossary term has not yet been described.. Jaimes et al. [1] recently described 3 different dermoscopy patterns for this entity:


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Focal islands of pigmentation

The most frequent pattern is called "patchy peripheral pigmented islands’’, which consist of focal islands of pigmentation (network or structure-less areas) located towards the periphery of the lesion. Toward the center focal featureless areas, most often scar-like or hypopigmented, are observed. 13 (7%) of those melanomas had crystalline structures, and 21 (11.3%) revealed vascular blush, most commonly within the focal hypopigmented areas. This pattern was most frequently seen on the back (n = 43; 61.4%) and were rather large with an average size of 10.72 mm


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Angulated line pattern

The second most common dermoscopic pattern is called ‘‘angulated line pattern’’; this was composed of angulated lines with or without the presence of granularityThis glossary term has not yet been described. or circle within a circle and was most commonly seen on the upper extremities.


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Tan structureless areas with granularity

The third pattern, consisted of lesions with tan structureless areas and granularity. These lesions had the smallest average diameter (7.39 mm) and occurred most frequently on the back.


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Non-Specific pattern

21.5% of the lesions in this series did not have one of the 3 pattern describes previously but showed granularity, atypical networkNetwork with increased variability in the color, thickness, and spacing of the lines of the network; asymmetrically distributed; gray color, peripheral tan structureless areas, atypical aggregated dotsThis glossary term has not yet been described./globulesThis glossary term has not yet been described., dotted vesselstiny pinpoint vessels flat melanocytic lesions inflammatory diseases Bowen disease, milky red areasMilky-white appearance or pinkish structureless areas ("strawberry and ice cream"-like), consisting a red vascular blush with no specific distinguishable vessels/vascular blush, serpentine vesselslinear irregular linear vessels with multiple bends flat BCC melanoma, asymmetric perifollicular hyperpigmentation, angulated linesstreaks, crystalline structures, and scar-like areas, negative networkSerpiginous interconnecting broadened hypopigmented lines that surround elongated and curvilinear globules., off-centered blotchDark structureless areas, and blue-white veil. Melanomas with a nonspecific pattern were more frequently seen on the back.




References
  1. Jaimes et al.: Clinical and dermoscopic characteristics of melanomas on nonfacial chronically sun-damaged skin. J. Am. Acad. Dermatol. 2015;72:1027-35. PMID: 25824275. DOI.