Complex melanoma of the scalp: Diagnosis and management aided by confocal microscopy

Pereira, Amanda; Guitera, Pascale; Ferguson, Peter M.; Ch’ng, Sydney; Hirata, Sérgio Henrique

doi:10.1111/ajd.13735

Cited by 1 publication

(2 citation statements)

References 10 publications

(42 reference statements)

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“…A cost-effective approach to increase diagnostic accuracy in this scenario would be adding a second noninvasive diagnostic step with in vivo reflectance confocal microscopy (RCM) for lesions showing equivocal features on dermoscopy [35, 36]. RCM has been proven to be an accurate tool (93% sensitivity, 82% specificity) to differentiate LM from equivocal pigmented macules of the face [37], and the main positive features for malignancy on RCM were also observed in scalp melanomas [22, 38, 39]. RCM can also provide guidance for partial biopsies of large lesions, reducing unnecessary excisions [37, 39].…”

Section: Discussionmentioning

confidence: 99%

“…RCM has been proven to be an accurate tool (93% sensitivity, 82% specificity) to differentiate LM from equivocal pigmented macules of the face [37], and the main positive features for malignancy on RCM were also observed in scalp melanomas [22, 38, 39]. RCM can also provide guidance for partial biopsies of large lesions, reducing unnecessary excisions [37, 39].…”

Section: Discussionmentioning

confidence: 99%

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Dermoscopy of Lentiginous Melanomas and Equivocal Benign Pigmented Macules of the Scalp: A Case-Control Multicentric Study

Regio Pereira,

Hirata,

Pietkiewicz

et al. 2023

Dermatology

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Introduction: Although the dermoscopic features of facial lentiginous melanomas (LM), including lentigo maligna and lentigo maligna melanoma, have been extensively studied, the literature about those located on the scalp is scarce. This study aims to describe the dermoscopic features of scalp LM and assess the diagnostic accuracy of dermoscopy to discriminate them from equivocal benign pigmented macules. Methods: Consecutive cases of scalp LM and histopathology-proven benign but clinically equivocal pigmented macules (actinic keratoses, solar lentigos, seborrhoeic keratoses, and lichen planus-like keratoses) from four referral centres were included. Dermoscopic features were analysed by two blinded experts. The diagnostic performance of a predictive model was assessed. Results: 56 LM and 44 controls were included. Multiple features previously described for facial and extrafacial LM were frequently identified in both groups. Expert’s sensitivity to diagnose scalp LM was 76.8% (63.6–87.0) and 78.6% (65.6–88.4), with specificity of 54.5% (38.9–69.6) and 56.8% (41.0–71.7), and fair agreement (kappa coefficient 0.248). The strongest independent predictors of malignancy were (OR, 95% CI) chaos of colour (15.43, 1.48–160.3), pigmented reticular lines (14.96, 1.68–132.9), increased density of vascular network (3.45, 1.09–10.92), and perifollicular grey circles (2.89, 0.96–8.67). The predictive model achieved 85.7% (73.8–93.6) sensitivity, 61.4% (45.5–75.6) specificity, and 81.5 (73.0–90.0) area under curve to discriminate benign and malignant lesions. A diagnostic flowchart was proposed, which should improve the diagnostic performance of dermoscopy. Conclusion: Both facial and extrafacial dermoscopic patterns can be identified in scalp LM, with considerable overlap with benign pigmented macules, leading to low specificity and interobserver agreement on dermoscopy.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Dermoscopy of Lentiginous Melanomas and Equivocal Benign Pigmented Macules of the Scalp: A Case-Control Multicentric Study

Regio Pereira,

Hirata,

Pietkiewicz

et al. 2023

Dermatology

View full text Add to dashboard Cite

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Complex melanoma of the scalp: Diagnosis and management aided by confocal microscopy

Abstract: Melanomas of lentigo maligna subtype are a steadily growing problem and frequently represent a clinical challenge. A case is reported of a complex melanoma of the scalp illustrating the critical role of confocal microscopy for optimal diagnosis and management.

Cited by 1 publication

References 10 publications

Dermoscopy of Lentiginous Melanomas and Equivocal Benign Pigmented Macules of the Scalp: A Case-Control Multicentric Study

Dermoscopy of Lentiginous Melanomas and Equivocal Benign Pigmented Macules of the Scalp: A Case-Control Multicentric Study

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