Superficial Spreading Melanoma

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Description Dermoscopy of superficial spreading melanoma (SSM)
Author(s) Aimilios Lallas
Responsible author Aimilios Lallas→ send e-mail
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Status update August 20, 2017
Status by Ralph P. Braun


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Dermoscopy significantly improves the sensitivity and specificity of clinicians for melanoma diagnosis.[1] 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.[2]

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-macroscopic 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.[2][3] Furthermore, local dermoscopic features associated with melanoma are the following:


Dermoscopic features associated with melanoma.jpeg

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.[4][5][6] 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.[7]

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.[4][5][6] 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.[2][8][9][10]

Here is one example of some dermoscopic features seen in superficial spreading melanoma:

SSM.jpg




References

  1. Vestergaard et al.: Dermoscopy compared with naked eye examination for the diagnosis of primary melanoma: a meta-analysis of studies performed in a clinical setting. Br. J. Dermatol. 2008;159:669-76. PMID: 18616769. DOI.
  2. 2.02.12.2 Argenziano et al.: Dermoscopy--the ultimate tool for melanoma diagnosis. Semin Cutan Med Surg 2009;28:142-8. PMID: 19782937. DOI.
  3. Babino et al.: Dermoscopy of melanoma and non-melanoma skin cancer. G Ital Dermatol Venereol 2015;150:507-19. PMID: 26184795.
  4. 4.04.1 Argenziano et al.: Epiluminescence microscopy for the diagnosis of doubtful melanocytic skin lesions. Comparison of the ABCD rule of dermatoscopy and a new 7-point checklist based on pattern analysis. Arch Dermatol 1998;134:1563-70. PMID: 9875194.
  5. 5.05.1 Argenziano et al.: Dermoscopy features of melanoma incognito: indications for biopsy. J. Am. Acad. Dermatol. 2007;56:508-13. PMID: 17113189. DOI.
  6. 6.06.1 Lallas et al.: Management rules to detect melanoma. Dermatology (Basel) 2013;226:52-60. PMID: 23485555. DOI.
  7. Argenziano et al.: Seven-point checklist of dermoscopy revisited. Br. J. Dermatol. 2011;164:785-90. PMID: 21175563. DOI.
  8. Nachbar et al.: The ABCD rule of dermatoscopy. High prospective value in the diagnosis of doubtful melanocytic skin lesions. J. Am. Acad. Dermatol. 1994;30:551-9. PMID: 8157780.
  9. Menzies et al.: Frequency and morphologic characteristics of invasive melanomas lacking specific surface microscopic features. Arch Dermatol 1996;132:1178-82. PMID: 8859028.
  10. Kittler H. Dermatoscopy: introduction of a new algorithmic method based on pattern analysis for diagnosis of pigmented skin lesions. Dermatopathology:Practical and Conceptual 2007