Melanoma specific structures
|Description||This chapter describes the 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. of melanomaThis glossary term has not yet been described. specific structuresThis glossary term has not yet been described.|
|Author(s)||Ralph P. Braun · Aimilios Lallas · Ashfaq A. Marghoob|
|Owner||Ash Marghoob → send e-mail|
|Status update||July 2, 2018|
|Status by||Ralph P. Braun|
Almost all melanomas will reveal at least one of the following structures/features:
- Atypical networkNetwork with increased variability in the color, thickness, and spacing of the lines of the network; asymmetrically distributed; gray color
Typical networkNetwork with minimal variability in the color thickness and spacing of the lines; symmetrically distributed consists of brown lines with minimal variability in their colorColor (American English) or colour (Commonwealth English) is the characteristic of human visual perception described through color categories, with names such as red, yellow, purple, or blue. and thickness. The holes of the networkThis glossary term has not yet been described. are of similar size. Atypical network consists of lines with increased variability in color and thickness. The atypical lines are often broadened, smudgy in appearance and often have a grayish color.
- Angulated linesSyn: polygons, zig-zag pattern Gray-brown lines that are connected at an angle or coalescing to form polygons
- Negative networkSerpiginous interconnecting broadened hypopigmented lines that surround elongated and curvilinear globules.
- Atypical streakslines radial (always at periphery) streaks Reed nevus melanoma recurrent nevus
Typical streaks consist of streaks arranged symmetrically around the entire perimeter of the lesion as seen in Reed’s neviThis glossary term has not yet been described..
Atypical streaks consist of streaks that are only focally present at the periphery.
Typical dots consist of dots that are centrally located within an otherwise organized lesion or dots associated with a typical networkNetwork with minimal variability in the color thickness and spacing of the lines; symmetrically distributed. The typical dost associated with a typical network are located on the network lines on in the holes of the network. Any other manifestation of dots is considered atypical.
Atypical dots are distributed asymmetrically, are not clustered in the center and are associated with an atypical networkNetwork with increased variability in the color, thickness, and spacing of the lines of the network; asymmetrically distributed; gray color. Typical globules are those found in nevi described in step-1 of this algorithmIn mathematics and computer science, an algorithm (Listeni/ˈælɡərɪðəm/ AL-gə-ri-dhəm) is a self-contained sequence of actions to be performed. Algorithms can perform calculation, data processing and automated reasoning tasks.. Globules of similar shape, size and color distributed throughout the lesion (including cobblestone), at the periphery of an otherwise reticular nevusThis glossary term has not yet been described., or in the center of an otherwise reticular pattern nevus are considered typical.
Any other manifestation of globules would be considered atypical.
- Peripheral tan structureless areas
- Atypical blotches
Typical blotchDark structureless areas consists of one round to oval homogeneous blotch in the center of an otherwise reticular pattern nevus.
Atypical blotch consists of an off center blotch or the presence of multiple blotches. The blotches can have irregular shapes and hues.
- Multiple small hyperpigmented areas of irregular shape
- Accentuated skin markings
- Blue-white veil over raised areas
- Regression structuresThis glossary term has not yet been described. (flat, non-palpable areas)
- GranularityThis glossary term has not yet been described. / pepperingGray dots
- Scar lie depigmentation
- Blue-white veil over flat area
- Shiny white linesstreaksThis glossary term has not yet been described.
- Comma vesselslinear curved short vessels dermal nevi in flat lesions (not IDNThis glossary term has not yet been described.)
- Dotted vesselstiny pinpoint vessels flat melanocytic lesions inflammatory diseases Bowen disease
- Serpentine or linear vesselsLinear mildly curved vessels considered irregular when different sizes shapes and curves with a haphazard or random distribution are presented and considered regular when short and fine (thin) linear vessels prevail various diagnoses
- Milky red areasMilky-white appearance or pinkish structureless areas ("strawberry and ice cream"-like), consisting a red vascular blush with no specific distinguishable vessels and globules
- Polymorphous pattern. The most common pattern is one with both dotted and serpentine vesselslinear irregular linear vessels with multiple bends flat BCC melanoma
- Corkscrew vesselstwisted looped vessels with bends twisted along a central axis melanoma metastasis
Volar: melanomas on the palmsThis glossary term has not yet been described. and solesThis glossary term has not yet been described.
- Parallel ridge patternVolar pigmentation forming lines, parallel, diffuse and irregular, along the ridges or cristae superficiales (raised portion of the dermatoglyphics)
- Atypical fibrillar patternLinear pigmented filamentous lines of similar length with one end at the furrows and oriented at a certain angle to the furrows and crossing the ridges
- Diffuse pigmentation with multiple shades of brown
- Multi-component pattern
Faceis a central body region of sense and is also very central in the expression of emotion among humans and among numerous other species.
- Annular-granular patterndots gray and circles gray
- Asymmetric follicular openings
- Gray 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)./granules around ostial openings
- Circle within circle sign
- Angulated lines forming rhomboidsGray-brown angulated lines forming a polygonal shape around adnexal ostial openings.
The presence of melanin inclusions defines the lesion as melanocyticThis glossary term has not yet been described.. These lesions consist of melanocyte activation as seen in lentigo or melanocytic proliferation as seen in nevi and melanoma. While evaluating the nailThis glossary term has not yet been described. plate it is important not to overlook evaluating the paronychia (micro-Hutchinson’s sign) area and hyponychial skin (parallel ridge patternVolar pigmentation forming lines, parallel, diffuse and irregular, along the ridges or cristae superficiales (raised portion of the dermatoglyphics) will be seen).
- Atypical bands
The features to define early mucosal melanoma have not yet been elucidated. Clearly any lesion with a multi-component pattern should be viewed with suspicion. In addition, any lesion manifesting the colors blue, gray or white should be view with concern for melanoma.