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Dermoscopy, Confocal Microscopy, and Histopathologic Correlates

Sonia Segura, MD; Giovanni Pellacani, MD; Susana Puig, PhD; Caterina Longo, MD; Sara Bassoli, MD; Pascale Guitera, MD; Josep Palou, MD; Scott Menzies, MB BS, PhD; Stefania Seidenari, MD; Josep Malvehy, MD

Arch Dermatol. 2008;144(10):1311-1320.

Objective  To characterize nodular melanoma (NM) using dermoscopy, in vivo reflectance-mode confocal microscopy, and histopathologic analysis.

Design  Consecutive pure NMs and superficial spreading melanomas (SSMs) with nodular or blue areas were studied using dermoscopy and confocal microscopy, and a correlation with histopathologic findings was performed.

Materials  Ten NMs, 10 SSMs with a nodular area, and 10 SSMs with a blue palpable but not yet nodular area.

Main Outcome Measure  Confocal differences within the nodular component between pure NMs and SSMs with a nodular area, hypothesizing different biological behaviors.

Results  Whereas NMs had predominantly nonspecific global dermoscopic patterns, SSMs exhibited a multicomponent pattern and higher dermoscopic scores. Globules, blue-white veil, atypical vessels, and structureless areas were frequent in NMs and in nodular areas from SSMs. At confocal microscopy, NMs exhibited few pagetoid cells within a typical epidermal architecture in the superficial layers in most cases, differing from SSMs frequently characterized by epidermal disarrangement and pagetoid infiltration. At the dermoepidermal junction, dermal papillae were rarely seen in nodular areas both from NMs and from SSMs, frequently substituted by nonaggregated atypical cells distributed in sheetlike structures. In the upper dermis, all groups exhibited plump bright cells, dense dishomogeneous cell clusters, and atypical nucleated cells, whereas cerebriform clusters were characteristic of NMs.

Conclusion  Distinctive dermoscopic and confocal features seen in NMs compared with SSMs are helpful in making the diagnosis and suggest different biological behavior.

Author Affiliations: Departments of Dermatology, Hospital Clinic, Barcelona, Spain (Drs Segura, Puig, Palou, and Malvehy), and University of Modena and Reggio Emilia, Modena and Reggio Emilia, Italy (Drs Pellacani, Longo, Bassoli, and Seidenari); and Sydney Melanoma Diagnostic Centre, Sydney Cancer Centre, and Dermatology Department, Royal Prince Alfred Hospital, University of Sydney, Sydney, Australia (Drs Guitera and Menzies).

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