Skin of Color - research needed

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 Author(s): Richard Usatine, Rachel Manci

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Description	Developing a greater knowledge of the dermoscopic features in skin cancers in darker skin could help with earlier diagnosis and improved patient outcomes.
Author(s)	Rachel Manci · Richard Usatine
Responsible author	Richard Usatine → send e-mail
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Status update	May 11, 2021
Status by	Ralph P. Braun

Color, Dermoscopy, Skin Skin of Color - research needed – cite! Skin of Color - research needed (message) Skin of Color - research needed – participate!

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THE NEED FOR FUTURE RESEARCH:

Most of our knowledge regarding the dermoscopic features of skin cancers is obtained from studies predominately including White individuals. We know that dermatologic conditions present differently across the various skin types, so we cannot directly translate our knowledge of lighter skin to those with darker skin.1 It is essential that we improve our understanding of dermoscopy in those of color, especially since these individuals are often faced with higher disease-associated morbidity and mortality.1 Developing a greater knowledge of the dermoscopic features in skin cancers in darker skin could help with earlier diagnosis and improved patient outcomes.

Benign volar ethnic melanosis vs Melanoma:

Individuals of color often have benign pigmented lesions on their acral surfaces, ultimately complicating the diagnosis of melanoma on these surfaces.2 We are in need of large-scale studies to better determine the dermoscopic features that will help differentiate benign macules from melanomas on acral surfaces.

Coleman WP 3rd, Gately LE 3rd, Krementz AB, Reed RJ, Krementz ET. Nevi, lentigines, and melanomas in blacks. Arch Dermatol. 1980

The parallel ridge pattern (PRP) is generally accepted as a robust diagnostic criterion for acral lentiginous melanoma (ALM), but the studies that have validated this feature primarily included White individuals.3,4 The PRP has high sensitivity and specificity for the diagnosis of ALM in White persons but its predictive value in skin of color is unknown. Studies have suggested that this pattern is only rarely found in the acral nevi of those with light skin tones.5-8 However, reports have also suggested that the PRP can be visualized in benign volar ethnic melanosis, thus complicating the diagnosis of ALM in those with darker skin tones.9 Other non-malignant lesions that have been reported to display the PRP include acral macules associated with Peutz-Jeghers syndrome, anti-cancer hyperpigmentation, acral sub-corneal hemorrhage, and pigmented warts.10-14 While further research is warranted, it has been suggested that the PRP in malignant lesions exhibits obliteration of the acrosyringia; preservation of the acrosyringia may help suggest the pattern is not melanoma.14,15 Since benign acral lesions are quite common in those with darker skin tones and the PRP pattern is seen in some of these benign lesions, utilization of the PRP would lead to an escalation of biopsies.

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  All of these Black individuals had benign ethnic melanosis with no changes in the macules in the last year.

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  All of these Black individuals had benign ethnic melanosis with no changes in the macules in the last year.

Ethnic melanonychia vs Nail melanoma:

Individuals with darker skin tones often have benign pigmented nail bands. It can be difficult to differentiate this benign melanocytic proliferation (ethnic melanonychia) from nail-matrix melanoma. Small-scale observational studies have suggested that gray coloration and regular spacing are suggestive of benign processes, and irregular brown-to-black lines are indicative of melanoma.16 However, large-scale studies would be helpful to develop more validated criteria for the differentiation of these two entities.

References:

1. Higgins S, Nazemi A, Chow M, Wysong A. Review of Nonmelanoma Skin Cancer in African Americans, Hispanics, and Asians. Dermatol Surg. 2018;44(7):903-910. doi:10.1097/DSS.0000000000001547
2. Bhalla M, Garg S. Acral melanosis. Pigment Int. 2018;5:14-27.
3. Phan A, Dalle S, Touzet S, Ronger-Savlé S, Balme B, Thomas L. Dermoscopic features of acral lentiginous melanoma in a large series of 110 cases in a white population. Br J Dermatol. 2010;162(4):765-771. doi:10.1111/j.1365-2133.2009.09594.x
4. Ishihara Y, Saida T, Miyazaki A, et al. Early acral melanoma in situ: correlation between the parallel ridge pattern on dermoscopy and microscopic features. Am J Dermatopathol. 2006;28(1):21-27. doi:10.1097/01.dad.0000187931.05030.a0
5. Saida T, Miyazaki A, Oguchi S, et al. Significance of dermoscopic patterns in detecting malignant melanoma on acral volar skin: results of a multicenter study in Japan. Arch Dermatol. 2004;140(10):1233-1238. doi:10.1001/archderm.140.10.1233
6. Emiroglu N, Cengiz FP, Onsun N. Age and Anatomical Location-Related Dermoscopic Patterns of 210 Acral Melanocytic Nevi in a Turkish Population. J Cutan Med Surg. 2017;21(5):388-394. doi:10.1177/1203475417712496
7. Altamura D, Altobelli E, Micantonio T, Piccolo D, Fargnoli MC, Peris K. Dermoscopic patterns of acral melanocytic nevi and melanomas in a white population in central Italy. Arch Dermatol. 2006;142(9):1123-1128. doi:10.1001/archderm.142.9.1123
8. Saida T, Oguchi S, Miyazaki A. Dermoscopy for acral pigmented skin lesions. Clin Dermatol. 2002;20(3):279-285. doi:10.1016/s0738-081x(02)00219-5
9. Phan A, Dalle S, Marcilly MC, Bergues JP, Thomas L. Benign dermoscopic parallel ridge pattern variants. Arch Dermatol. 2011;147(5):634. doi:10.1001/archdermatol.2011.47
10. Tanioka M. Benign acral lesions showing parallel ridge pattern on dermoscopy. J Dermatol. 2011;38(1):41-44. doi:10.1111/j.1346-8138.2010.01128.x
11. Tognetti L, Fimiani M, Rubegni P. Benign dermoscopic parallel ridge pattern in plantar hyperpigmentation due to capecitabine. Dermatol Pract Concept. 2015;5(2):79-81. Published 2015 Apr 30. doi:10.5826/dpc.0502a14
12. Noguchi H, Hiruma M, Inoue Y, Miyata K, Tanaka M, Ihn H. Tinea nigra showing a parallel ridge pattern on dermoscopy. J Dermatol. 2015;42(5):518-520. doi:10.1111/1346-8138.12830
13. Jurakić Tončić R, Bradamante M, Ferrara G, Štulhofer-Buzina D, Petković M, Argenziano G. Parallel ridge dermoscopic pattern in plantar atypical Spitz nevus. J Eur Acad Dermatol Venereol. 2018;32(3):e101-e102. doi:10.1111/jdv.14575
14. Roldán-Marín R, González-de-Cossío-Hernández AC, Lammoglia-Ordiales L, Martínez-Luna E, Toussaint-Caire S, Ferrara G. Atypical dermoscopic presentation of an acral congenital melanocytic nevus in an adult: parallel ridge pattern and its histologic correlation. Dermatol Pract Concept. 2015;5(4):23-26. Published 2015 Oct 31. doi:10.5826/dpc.0504a06
15. Fracaroli TS, Lavorato FG, Maceira JP, Barcaui C. Parallel ridge pattern on dermoscopy: observation in non-melanoma cases. An Bras Dermatol. 2013;88(4):646-648. doi:10.1590/abd1806-4841.20132058
16. Singal A, Bisherwal K. Melanonychia: Etiology, Diagnosis, and Treatment. Indian Dermatol Online J. 2020;11(1):1-11. Published 2020 Jan 13. doi:10.4103/idoj.IDOJ_167_19

Links to additional chapters on Skin of Color

• Dermoscopy of Skin of Color