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- Presentation
High Yield Melanoma Dermoscopy Tips for the General Dermatologist: How to Diagnose Acral Melanoma
Description
The presentation focuses on dermoscopy techniques for diagnosing acral melanoma, emphasizing the unique anatomical features of acral skin, such as ridges and furrows. It explains that in benign nevi, pigment is generally found in the furrows, while in melanoma, pigmentation tends to be associated with the ridges, leading to the guideline "furrows are fine, ridges are risky." One technique highlighted is the "furrow ink test" to differentiate where pigmentation lies. An algorithm for evaluating acquired flat dark spots is also presented, beginning with checking for a parallel ridge pattern, which indicates a high likelihood of melanoma and should prompt a biopsy if present. Conversely, typical benign patterns such as parallel furrow, lattice-like, and fibrillar patterns can reassure patients. Non-typical patterns warrant the use of the BRAF scoring system, where various features contribute points towards a melanoma diagnosis. Advanced lesions may show conventional melanoma structures, necessitating immediate biopsy. The discussion also addresses congenital acral nevi, distinguishing them from acquired lesions, with an emphasis on careful monitoring and the rarity of acral melanoma in children. Ultimately, the key takeaway is to adopt a systematic approach in identifying suspicious lesions on acral sites, underscoring the importance of thorough evaluations and appropriate biopsies.
View moreConclusions
- Dermoscopic features of acral melanomas differ from those of benign nevi, specifically in the arrangement of pigment in relation to the skin's ridges and furrows.
- Pigmentation on the ridges indicates potential melanoma, while pigmentation in the furrows is associated with benign lesions.
- The presence of a parallel ridge pattern is highly sensitive (86%) and specific (99%) for diagnosing acral melanoma.
- Dermatologists should employ the 'furrow ink test' to differentiate between ridges and furrows when assessing pigmented lesions on acral skin.
- Various benign patterns exist in acral skin, including parallel furrow, lattice-like, and fibrillar patterns, which generally indicate non-melanoma lesions.
- The BRAAFF algorithm can assist in diagnosing acral melanoma with a scoring system based on specific visual characteristics of the lesions.
- Acral melanoma is often less predictable in patients with skin of color, where size and non-standard patterns should be assessed carefully.
- Congenital acral nevi can appear at birth and may change frequently, but they typically present with benign characteristics that require monitoring rather than immediate intervention.
- Any lesion larger than 7mm on acral skin should be biopsied to ensure accurate diagnosis, particularly if suspicious features are present.
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