Difference in distribution of malignant melanoma and melanocytic nevus in the palm and finger

Nishiguchi, Mana; Yamamoto, Yuki; Hara, Tomoyuki; Okuhira, Hisako; Inaba, Yutaka; Kunimoto, Kayo; Mikita, Naoya; Kaminaka, Chikako; Kanazawa, Nobuo; Jinnin, Masatoshi

doi:10.5582/bst.2019.01221

Cited by 7 publications

(13 citation statements)

References 4 publications

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“…Second, studies were specifically focused either on inconspicuous benign-looking acral nevi (with a diagnosis mainly estimated by consensus and follow-up, in the absence of a histologic definitive histopathologic diagnosis) [ 29 , 30 , 31 , 32 , 36 , 37 , 38 , 41 , 48 , 49 , 50 , 51 ] or on acral melanomas [ 42 , 43 , 44 , 47 ]. Third, the anatomic distribution of MPPLs was rarely investigated and, in those cases, most exclusively in Eastern Asiatic and/Turkish populations, on foot plantar lesions in monocentric case studies [ 41 , 52 , 53 , 54 , 55 , 56 ]. In parallel, it seems that the knowledge regarding the peculiar “acral dermoscopic glossary” [ 28 ] is not as comprehensive as the dermoscopic glossary for body or facial lesions, being almost inadequate to cover the spectrum of aMPPLs [ 18 , 19 , 20 , 21 , 33 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 ].…”

Section: Discussionmentioning

confidence: 99%

Pattern Analysis of Benign and Malignant Atypical Melanocytic Skin Lesions of Palms and Soles: Variations of Dermoscopic Features According to Anatomic Site and Personal Experience

Tognetti,

Cartocci,

Moscarella

et al. 2024

Life

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Background: The differential diagnosis of atypical melanocytic skin lesions localized on palms and soles represents a diagnostic challenge: indeed, this spectrum encompasses atypical nevi (AN) and early-stage melanomas (EN) displaying overlapping clinical and dermoscopic features. This often generates unnecessary excisions or delayed diagnosis. Investigations to date were mostly carried out in specific populations, focusing either on acrolentiginous melanomas or morphologically typical acquired nevi. Aims: To investigate the dermoscopic features of atypical melanocytic palmoplantar skin lesions (aMPPLs) as evaluated by variously skilled dermatologists and assess their concordance; to investigate the variations in dermoscopic appearance according to precise location on palms and soles; to detect the features with the strongest association with malignancy/benignity in each specific site. Methods: A dataset of 471 aMPPLs—excised in the suspect of malignancy—was collected from 10 European Centers, including a standardized dermoscopic picture (17×) and lesion/patient metadata. An anatomical classification into 17 subareas was considered, along with an anatomo-functional classification considering pressure/friction, (4 macroareas). A total of 156 participants (95 with less than 5 years of experience in dermoscopy and 61 with ≥than 5 years) from 17 countries performed a blinded tele-dermoscopic pattern analysis over 20 cases through a specifically realized web platform. Results: A total of 37,440 dermoscopic evaluations were obtained over 94 (20%) EM and 377 (80%) AN. The areas with the highest density of EM compared to AN were the heel (40.3% EM/aMPPLs) of the sole and the “fingers area” (33%EM/aMPPLs) of the palm, both characterized by intense/chronic traumatism/friction. Globally, the recognition rates of 12 dermoscopic patterns were non statistically different between 95 dermatology residents and 61 specialists: aMPPLs in the plantar arch appeared to be the most “difficult” to diagnose, the parallel ridge pattern was poorly recognized and irregular/regular fibrillar patterns often misinterpreted. Regarding the aMPPL of the “heel area”, the parallel furrow pattern (p = 0.014) and lattice-like pattern (p = 0.001) significantly discriminated benign cases, while asymmetry of colors (p = 0.002) and regression structures (p = 0.025) malignant ones. In aMPPLs of the “plantar arch”, the lattice-like pattern (p = 0.012) was significant for benignity and asymmetry of structures, asymmetry of colors, regression structures, or blue-white veil for malignancy. In palmar lesions, no data were significant in the discrimination between malignant and benign aMPPLs. Conclusions: This study highlights that (i) the pattern analysis of aMPPLs is challenging for both experienced and novice dermoscopists; (ii) the histological distribution varies according to the anatomo-functional classification; and (iii) different dermoscopic patterns are able to discriminate malignant from benign aMPPLs within specific plantar and palmar areas.

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Section: Discussionmentioning

confidence: 99%

Pattern Analysis of Benign and Malignant Atypical Melanocytic Skin Lesions of Palms and Soles: Variations of Dermoscopic Features According to Anatomic Site and Personal Experience

Tognetti,

Cartocci,

Moscarella

et al. 2024

Life

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“…The current knowledge on clinical and epidemiologic features of PP nevi delineates the profile of a small (usually under 6 mm) macule, symmetric in shape and with homogenous pigmentation [ 9 , 13 , 16 , 38 ], and mainly derive from Asiatic [ 4 , 39 , 40 ] or South American countries [ 4 , 41 , 42 ], with fewer reports from South European countries [ 2 , 7 , 9 ]. However, equivocal aMPPLs have been poorly or not investigated, especially in Europe [ 26 ].…”

Section: Discussionmentioning

confidence: 99%

A European Multicentric Investigation of Atypical Melanocytic Skin Lesions of Palms and Soles: The iDScore-PalmoPlantar Database

Tognetti,

Cartocci,

Lallas

et al. 2024

Diagnostics

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Background: The differential diagnosis of atypical melanocytic palmoplantar skin lesions (aMPLs) represents a diagnostic challenge, including atypical nevi (AN) and early melanomas (MMs) that display overlapping clinical and dermoscopic features. We aimed to set up a multicentric dataset of aMPL dermoscopic cases paired with multiple anamnestic risk factors and demographic and morphologic data. Methods: Each aMPL case was paired with a dermoscopic and clinical picture and a series of lesion-related data (maximum diameter value; location on the palm/sole in 17 areas; histologic diagnosis; and patient-related data (age, sex, family history of melanoma/sunburns, phototype, pheomelanin, eye/hair color, multiple/dysplastic body nevi, and traumatism on palms/soles). Results: A total of 542 aMPL cases—113 MM and 429 AN—were collected from 195 males and 347 females. No sex prevalence was found for melanomas, while women were found to have relatively more nevi. Melanomas were prevalent on the heel, plantar arch, and fingers in patients aged 65.3 on average, with an average diameter of 17 mm. Atypical nevi were prevalent on the plantar arch and palmar area of patients aged 41.33 on average, with an average diameter of 7 mm. Conclusions: Keeping in mind the risk profile of an aMPL patient can help obtain a timely differentiation between malignant/benign cases, thus avoiding delayed and inappropriate excision, respectively, with the latter often causing discomfort/dysfunctional scarring, especially at acral sites.

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“…These nevi may also occur on the volar surface of the fingers and toes. Acral melanocytic nevi have a different distribution on volar sites than acral melanomas, and primarily affect non-weight-bearing areas [ 13 , 14 , 15 ]. Most of these lesions present as brown-to-black small (less than 6 mm) macules or papules.…”

Section: Acral Melanocytic Nevusmentioning

confidence: 99%

“…In the abovementioned study of a White population, there were also significant associations with penetrative injury of the feet or hands and heavy exposure to agricultural chemicals [ 45 ]. Several recent studies, including ones conducted in our department, revealed an association of acral melanoma on the plantar or palmar surfaces with mechanical or physical stress through anatomical mapping [ 15 , 47 , 48 ]. Analysis in 313 Korean acral melanoma patients revealed that 26.8% reported traumatic events, and 29.1% experienced physical stress.…”

Section: Acral Melanomamentioning

confidence: 99%

“…Acral melanoma on the sole primarily occurs on the weight-bearing portions, including the heel and forefoot areas [ 47 , 48 ]. One study showed that acral melanoma on the palms tends to occur in the finger pulp and distal area of the distal transverse crease of the palm, and suggested that mechanical stress may also affect the occurrence of palmar melanoma [ 15 ]. Due to their long RGP and clinical similarity with acral melanocytic nevus, differential diagnoses can sometimes be difficult based only on clinical findings.…”

Section: Acral Melanomamentioning

confidence: 99%

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Acral Melanocytic Neoplasms: A Comprehensive Review of Acral Nevus and Acral Melanoma in Asian Perspective

Park

Yun

2022

Dermatopathology

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Acral melanocytic neoplasms, including acral melanocytic nevus and acral melanoma, are common melanocytic lesions in Asian populations. Both lesions occur on the volar surface of the hands and feet, and on nail units. Acral melanocytic nevi occur on the arch area of the sole, whereas acral melanomas frequently occur on weight-bearing areas of the sole, and on the fingernails. Therefore, the development of acral melanoma may be associated with chronic pressure, physical stress, or trauma. Dermoscopy is a useful adjunctive diagnostic tool for differential diagnosis. Acral melanocytic nevus is characterized by a parallel furrow pattern, whereas acral melanoma has a parallel ridge pattern. Genetic alterations are also different between the two types of lesion. BRAF and NRAS mutations are common in acral melanocytic nevus, whereas acral melanoma shows lower rates of KIT, NF1, BRAF, and NRAS mutations and remarkable copy number variations in genes such as CCND1, CDK4, hTERT, PAK1, and GAB2. Sentinel lymph node biopsy is important for staging and prognosis. Contemporary treatments for melanoma include targeted therapy for mutations and immunotherapy, such as anti-PD1 inhibitors.

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Difference in distribution of malignant melanoma and melanocytic nevus in the palm and finger

Cited by 7 publications

References 4 publications

Pattern Analysis of Benign and Malignant Atypical Melanocytic Skin Lesions of Palms and Soles: Variations of Dermoscopic Features According to Anatomic Site and Personal Experience

Pattern Analysis of Benign and Malignant Atypical Melanocytic Skin Lesions of Palms and Soles: Variations of Dermoscopic Features According to Anatomic Site and Personal Experience

A European Multicentric Investigation of Atypical Melanocytic Skin Lesions of Palms and Soles: The iDScore-PalmoPlantar Database

Acral Melanocytic Neoplasms: A Comprehensive Review of Acral Nevus and Acral Melanoma in Asian Perspective

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