Please login or create an account. If you do not have access to this content, you will be shown a 30 second preview and licensing options.
- Presentation
High Yield Melanoma Dermoscopy Tips for the General Dermatologist: How to Diagnose Acral Melanoma
Description
The presentation, led by Amanda Levine, emphasizes the diagnostic strategies for acral melanoma, particularly focusing on dermoscopy techniques. Acral skin's unique anatomy results in distinct dermoscopic features; benign nevi typically have nests of melanocytes around the furrows, while melanoma shows pigmentation along the ridges. Key techniques include the recognition of the parallel ridge pattern, which indicates a higher likelihood of melanoma and necessitates biopsy. If the lesion does not have this pattern, the practitioner should look for benign patterns such as the parallel furrow, lattice, or fibrillar patterns. The BRAF scoring system serves as a valuable tool, scoring various features of a lesion to assist in diagnosis, with a score of one or greater suggesting melanoma. Furthermore, lesion diameter is important: those over 7mm warrant biopsy, while smaller lesions should be monitored closely. Context is vital in interpretation, particularly when assessing lesions in patients of color or congenital nevi. Understanding these patterns and applying appropriate diagnostic algorithms can improve the accuracy of melanoma diagnoses in acral skin.
View moreConclusions
- Acral melanoma can be effectively diagnosed by recognizing distinct dermoscopic patterns on acral skin.
- Identifying the parallel ridge pattern is crucial as it indicates a higher risk for acral melanoma and has a high sensitivity and specificity for diagnosis.
- A furrow ink test can help differentiate between benign and malignant lesions by highlighting pigmentation patterns.
- A stepwise algorithm is proposed for evaluating new acral lesions based on ridge patterns, benign characteristics, and lesion size.
- The BRAF algorithm effectively assists in assessing potential acral melanoma based on specific dermoscopic criteria.
- Congenital acral nevi can present with features that mimic melanoma, requiring careful evaluation to avoid unnecessary biopsies.
- Acral lesions can display variation in malignancy risk among different skin types, particularly in individuals with skin of color.
- Close monitoring is advised for acral lesions smaller than 7mm with atypical patterns, while larger lesions should typically be biopsied.
- Uhara, H. et al. Arch Dermatol 2009;145:1331-1332.
- Lallas et al BJD (2015)173, pp1041-1049
- Oguchi, S. et al. Arch Dermatol 1998;134:563-568.
- Saida T, et al. Arch Dermatol. 2004;140:1233-1238.
- Marghoob A, Atlas of Dermoscopy. (Kwon et al ., 2004).
- Altamura, D. et al. Arch Dermatol 2006;142:1123-1128.
- Ozdemir, F. et al. Arch Dermatol 2007;143:1378-1384.
- Park, S. et al .. Dermatopathology 2022;9:292-303.
- Watanabe et al. 2014
- Saida T, et al Dermatol Pract Concept. 2022;12(03):e2022123.
- Han et al Nature 2020
- Nassar et al JDDS 2021
- Madankumar et al JAAD 2016
- Manci et al DPC Journal 2022
- Moscarella E, et al. BJD 2015.
- Minagawa, A. et al. Arch Dermatol 2011;147:809-813.