J EUR ACAD DERMATOL: DERMOSCOPY AND CONFOCAL PREDICTIVE DIAGNOSIS OF NONPIGMENTED OR HYPOCHROMIC MALIGNANT LENTIFORM NEVI

Nonpigmented or hypochromic malignant lentiform nevi and malignant lentiform nevus melanoma (AHLM/LMM) are difficult to diagnose at an early stage
.
At present, the predictive diagnostic value of AHLM/LMM features acquired using dermoscopy and reflection confocal microscopy (RCM) is unclear
.

A STUDY FROM J EUR ACAD DERMATO SHOWED THAT THE DERMOSCOPIC FEATURES OF AHLM/LMM CAN BE IDENTIFIED
.

The patient has AHLM/LMM, apigmented or hypochromic benign lesions (AHBL), non-pigmented or hypochromic basal and squamous cell carcinoma (AHBCC/AHSCC) on the head or neck, confirmed
by pathological tissue examination by dermoscopy and RCM imaging.
This review retrospectively collected patient data continuously and blinded by three researchers to analyze compliance with dermoscopy and RCM-related indicators
.
A total of 224 lesions in 216 patients were analyzed, including LM/LMM (n=55, 24.
6%), AHBL (n=107, 47.
8%), and AHBCC/AHSCC (n=62, 27.
7%)
.

1.
Multivariate analysis showed that the following features were clearly independent factors in the diagnosis of AHLM/LMM compared with AHBL: milky red region in dermoscopy (OR=5.
46; 95% CI, 1.
51-19.
75), peripheral hazel unstructured region (OR=19.
10; 95%CI, 4.
45-81.
96), irregularly distributed linear vessels (OR=5.
44; 95% CI, 1.
45-20.
40), and asymmetric pigment reticulum (OR= 14.
45；95%CI，2.
77-75
。 44), focal follicular localization of ≥ 3 atypical cells (OR=10.
12; 95% CI, 3.
00-34.
12) and atypical cells at the dermoepidermal junction (DEJ) in the RCM (OR=10.
48; 95% CI, 1.
10-99.
81).

2.
Compared with AHBCC/AHSCC, the following features were clearly independent factors in the diagnosis of AHLM/LMM: peripheral light brown unstructured area in dermoscopy (OR=7.
11; 95% CI, 1.
53-32.
96), pseudoreticular erythema at the base of hair follicles (OR=16.
69; 95% CI, 2.
73-102.
07) and ring granular structure (OR=42.
36; 95%CI, 3.
51-511.
16), Large dendritic cells (OR=6.
86; 95% CI, 3.
1-to-38.
28) and round pagetoid cells (OR=26.
78; 95% CI, 3.
15-227.
98)
in RCM.

AHLM/LMM may have the same dermoscopic features as AHM in other sites, such as milky red areas, peripheral hazel unstructured areas, and irregularly distributed linear vessels
.
Even if the traditional light microscopic features (e.
g.
, hair follicle occlusion under dermoscopy and large pagetoid cells under RCM) are present, and the above features are only present in a very small number of lesions, AHLM/LMM can be identified by the following features: asymmetric pigment web, focal follicular localization
of ≥ 3 atypical cells in 5 fields of view under RCM, and atypical cells at DEJ.