Enlarging melanocytic lesions with peripheral globular pattern: a dermoscopic and confocal microscopy study

Carbone, Anna; Persechino, Flavia; Paolino, Giovanni; Cota, Carlo; Piemonte, Paolo; Franceschini, Chiara; Eibenschutz, Laura; Ferrari, Ângela; Buccini, Pierluigi; Frascione, Pasquale; Calvieri, Stefano; Ardigò, Marco

doi:10.23736/s2784-8671.19.06471-x

Cited by 4 publications

(20 citation statements)

References 21 publications

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Section: Discussionmentioning

confidence: 99%

“…Concerning the anatomic site of MLPGs, the most common location was the torso and especially the back [5,[8][9][10], while the risk of finding a melanoma when removing an MLPG resulted significantly higher in the extremities and head/neck [5,9]. A gender prevalence of MPLGs was largely not reported except for two studies with controversial results [5,[8][9][10][11]. In addition, Pampìn-Francoin et al reported an average size of MLPGs of 4.1 mm with a significant association with the diagnosis of melanoma in lesions ≥6mm in diameter, as well as in MLPGs showing asymmetry in two axes [10].…”

Section: Discussionmentioning

confidence: 99%

“…The impact of patient age on clinical decision-making for MLPGs is well acknowledged but different thresholds and suggestions have been proposed [5,[8][9][10][11]. Williams et al eccentric blotches, tan structureless peripheral areas and vascularization are atypical dermoscopic features.…”

Section: Age and Clinical Datamentioning

confidence: 99%

“…The morphology and distribution of peripheral globules along with the presence of additional atypical features in MLPGs was recently investigated, with the objective to identify specific structures indicating a diagnosis of melanoma [8][9][10][11].…”

Section: Dermoscopymentioning

confidence: 99%

“…Recent studies have been focused on the clinical approach to MLPGs, providing further insights into MLPGs, however heterogeneous management strategies have been proposed and common practical indications are still missing [5,[8][9][10][11][12].…”

Section: Introductionmentioning

confidence: 99%

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Melanocytic Lesions With Peripheral Globules: Proposal Of An Integrated Management Algorithm

Cappilli

Ribero

Cornacchia

et al. 2023

Dermatol Pract Concept

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Introduction: A peripheral rim of globules represents a marker of horizontal growth phase in nevi and is a common feature in children and adolescents. The observation of melanocytic lesion with peripheral globules (MLPG) in adulthood deserve more attention, since a melanoma may exhibits this feature albeit rarely. Risk stratified management recommendations considering a global clinical approach are still missing. Objectives: To analyze current knowledge on MLPG and propose an integrated management algorithm stratified for age groups. Methods: We conducted a narrative review of current published data on MPLG, analyzing clinical dermoscopic and confocal distinguishing features of melanoma from bening nevi. Results: The risk of finding a melanoma when removing a MLPG increases with age especially in people >55 years old and results significantly higher on extremities, head/neck and in case of a single asymmetrical lesion, ≥6 mm in diameter. Dermoscopic features associated to melanoma diagnosis include atypical peripheral globules, asymmetrical distribution, multiple rims as well as globules reappearance after previous loss. In addition, wide blue-grey regression areas, atypical network, eccentric blotches, tan structureless peripheral areas and vascularizationare atypical dermoscopic features. Confocal worrisome findingss are represented by pagetoid cells within the epidermis, architectural disarrangement and atypical cells of the dermo-epidermal junction with irregular peripheral nests. Conclusion: We proposed a multi-step age-stratified management algorithm integrating clinical, dermoscopic and confocal findings that may increase the early recognition of melanoma and avoid surgical excision of benign nevi.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Age and Clinical Datamentioning

confidence: 99%

Section: Dermoscopymentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Melanocytic Lesions With Peripheral Globules: Proposal Of An Integrated Management Algorithm

Cappilli

Ribero

Cornacchia

et al. 2023

Dermatol Pract Concept

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Can we manage the melanocytic lesions with peripheral globules according to the grade of dysplasia?

Avcı,

Akın,

Lebe

et al. 2024

Aust J Dermatology

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Background/ObjectivesAlthough excision of melanocytic nevi with high‐grade dysplasia is recommended by the World Health Organization (WHO), clinical studies investigating the approach based on the grading dysplasia of melanocytic lesions with peripheral globules (PGs) are lacking. We investigated the grades of dysplasia and their distinguishable dermoscopic and clinical features to provide accurate data for managing these lesions.MethodsWe retrospectively classified histologically confirmed melanocytic lesions with PGs according to the 2018 WHO Classification of Skin Tumours criteria in a university hospital in Turkey. Dermoscopic features, lesions, and patient characteristics were recorded.ResultsSixty‐six lesions of 56 patients were included. After classification, 9.1% (n: 6) of lesions were melanomas, 39.4% (n: 26) were high‐grade dysplastic nevi, and 50% (n: 33) were low‐grade dysplastic nevi (n: 33, 50%). There was one nevus with no dysplasia (n: 1, 1.5%). Univariate analysis revealed that ≥31 years of age, irregular shape of peripheral globules, black colour, total colour count, and maximum diameter of the lesion were associated with high‐grade dysplasia and melanoma. In the multivariate analyses, ≥31 years of age (OR = 3.80, 95% CI, 1.17–12.37), irregular shape of peripheral globules (OR = 3.90, 95% CI, 1.15–13.2), and total colour count (OR = 3.21, 95% CI, 1.2–8.5) were significant predictive factors for the lesions with high‐grade dysplasia and melanomas.ConclusionsTo avoid the underdiagnosis of both melanomas and high‐grade dysplastic nevi with PGs, the irregular shape of peripheral globules and multiple colours after the third decade may be useful in making an excision decision. The risk increases every 1‐year increase in age. Excision is suggested for all melanocytic lesions with PGs for patients 60 years or older because of the high risk of melanoma and melanocytic nevus with high‐grade dysplasia.

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Association between the dermoscopic morphology of peripheral globules and melanocytic lesion diagnosis

Reiter

Chousakos

Kurtansky

et al. 2020

Acad Dermatol Venereol

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Background The presence of peripheral globules is associated with enlarging melanocytic lesions; however, there are numerous patterns of peripheral globules distribution and it remains unknown whether specific patterns can help differentiate enlarging naevi from melanoma. Objective To investigate whether morphological differences exist between the peripheral globules seen in different subsets of naevi and in melanoma. Methods A cross‐sectional study of clinical notes that mentioned peripheral globules, in addition to all melanoma images with peripheral globules on the International Skin Imaging Collaboration archive. Dermoscopic images were reviewed and annotated. Associations between diagnosis and categorical features were measured with odds ratios. Non‐parametric tests were used for continuous factors. Results 184 lesions with peripheral globules from our clinic were included in the analysis; only 6 of these proved to be melanoma. 109 melanomas with peripheral globules from the International Skin Imaging Collaboration archive were added to the analysis. Melanomas were more common on the extremities and among older individuals. Melanomas were more likely to display atypical, tiered and/or focal peripheral globules. Only 5% of melanomas lacked dermoscopic melanoma‐specific structures compared to 48% of naevi. Conclusions Melanocytic lesions with atypical or asymmetrically distributed peripheral globules, especially when located on the extremities, should raise suspicion for malignancy. Melanocytic lesions with typical and symmetrically distributed peripheral globules, and with no other concerning dermoscopic features, are unlikely to be malignant.

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Enlarging melanocytic lesions with peripheral globular pattern: a dermoscopic and confocal microscopy study

Cited by 4 publications

References 21 publications

Melanocytic Lesions With Peripheral Globules: Proposal Of An Integrated Management Algorithm

Melanocytic Lesions With Peripheral Globules: Proposal Of An Integrated Management Algorithm

Can we manage the melanocytic lesions with peripheral globules according to the grade of dysplasia?

Association between the dermoscopic morphology of peripheral globules and melanocytic lesion diagnosis

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