Superficial Spreading Melanoma
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Dermoscopy significantly improves the sensitivity and specificity of clinicians for melanoma diagnosis. The dual benefit of dermoscopy lays on its potential to allow the detection of clinically inconspicuous melanomas, while enabling the recognition of benign lesions that might look clinically worrisome, reducing, thus, the number of unnecessary excisions.
Melanoma becomes clinically recognizable at a certain progression point, after acquiring one or more of the ABCD clinical criteria. At an earlier stage, melanoma is macroscopically undetectable, since it is small in size and symmetric in terms of shape and color. At such an early stage, dermoscopy often uncovers sub-macrosroscopic morphologic criteria that allow melanoma recognition.
The dermoscopic criteria of melanoma are a result of its asymmetric growth and vary among different subtypes of the disease. The main dermoscopic features seen in superficial spreading melanoma of the trunk and the extremities are: As a rule, dermoscopy of superficial spreading melanoma of the trunk and the extremities reveals asymmetry of shape, more than 2 colors (light brown, dark brown, black, blue, gray, red, white) and asymmetry of structures. Furthermore, local dermoscopic features associated with melanoma are the following:
In the real clinical setting, the dermoscopic diagnosis of melanoma is usually straight-forward, based on the immediate recognition of its morphologic asymmetry and/or a combination of the structures described above. Obviously, the dermoscopic morphology of melanoma is less evident at an initial stage (melanoma in situ/early invasive), where only 1 (or even none) of these features might be present. The most frequent criteria of melanoma in situ are atypical network and regression.
As the tumor progresses, more dermoscopic criteria develop and the diagnosis is usually straight-forward, based on the immediate recognition of its morphologic asymmetry and a combination of the structures described above. However, less morphologically evident melanomas do exist, and in such cases, an analytic approach of the lesion is required. The firstly introduced and more widely adopted method for analysing the morphology of a pigmented lesion is the so-called 2-step algorithm, but also other methods do exist.
Here is one example of some dermoscopic features seen in superficial spreading melanoma:
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