Melanoma on sun damaged skin
|Description||In this chapter we describe the different dermoscopyThe examination of [skin lesions] with a 'dermatoscope'. This traditionally consists of a magnifier (typically x10), a non-polarised light source, a transparent plate and a liquid medium between the instrument and the skin, and allows inspection of skin lesions unobstructed by skin surface reflections. Modern dermatoscopes dispense with the use of liquid medium and instead use polarised light to cancel out skin surface reflections. 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|
|Responsible author||Ralph Braun → send e-mail|
|Status update||May 29, 2017|
|Status by||Ralph P. Braun|
Identifying melanomas located on chronically sun-damaged skin (CSDS) is challenging because their characteristics often clinically overlap with benignis any condition that is harmless in the long run lesions. DermoscopyThe examination of [skin lesions] with a 'dermatoscope'. This traditionally consists of a magnifier (typically x10), a non-polarised light source, a transparent plate and a liquid medium between the instrument and the skin, and allows inspection of skin lesions unobstructed by skin surface reflections. Modern dermatoscopes dispense with the use of liquid medium and instead use polarised light to cancel out skin surface reflections. 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 faceis a central body region of sense and is also very central in the expression of emotion among humans and among numerous other species., primarily lentigo maligna are well described (see chapter). These descriptions may be dependent on the specific anatomic structure of the facial skinThis glossary term has not yet been described. (ie, absence of rete ridgeThis glossary term has not yet been described. pattern and presence of pilosebaceous structuresThis glossary term has not yet been described. 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 skin. Jaimes et al.  recently described 3 different dermoscopy patternsThis glossary term has not yet been described. for this entity:
Focal islands of pigmentation
The most frequent pattern is called "patchy peripheral pigmented islands’’, which consist of focal islands of pigmentation (networkThis glossary term has not yet been described. or structure-less areas) located towards the periphery of the lesion. Toward the center focal featureless areas, most often scar-like or hypopigmentedThis glossary term has not yet been described., 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
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 circlecircles concentric and was most commonly seen on the upper extremities.
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.
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 dotsDots are small, round structures of less than 0.1 mm in diameter that have a red color when corresponding to blood vessels; however, when due to melanin, their color ranges from black, brown, to blue-gray depending on the depth and concentration of the melanin in the skin (Tyndall effect)./globulesThis glossary term has not yet been described., dotted vesselstiny pinpoint vessels, 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 vessels with multiple bends. Seen with flat BCC and melanoma, asymmetric perifollicular hyperpigmentation, angulated linesSyn: polygons, zig-zag pattern Gray-brown lines that are connected at an angle or coalescing to form polygons, 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.
ReferencesThis is material contained in a footnote or bibliography holding further information.