Practical Dermoscopy
SARS-CoV-2 Spike-like Pigmented Peripheral Structures: A Dermoscopic Finding in Dysplastic Nevi and Incipient Melanomas
Estructuras pigmentadas periféricas de morfología similar a las espículas del SARS-CoV-2 como hallazgo dermatoscópico sugerente de nevo displasico y melanoma incipiente
A. Martin-Gorgojo
, J.L. Ramírez-Bellver, R. Ruiz-Rodríguez, Á. Pizarro
Corresponding author
Clínica Dermatológica Internacional, Madrid, Spain
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"apellidos" => "Martin-Gorgojo" "email" => array:1 [ 0 => "alejandromartingorgojo@aedv.es" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "*" "identificador" => "cor0005" ] ] ] 1 => array:2 [ "nombre" => "J.L." "apellidos" => "Ramírez-Bellver" ] 2 => array:2 [ "nombre" => "R." "apellidos" => "Ruiz-Rodríguez" ] 3 => array:2 [ "nombre" => "Á." "apellidos" => "Pizarro" ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Clínica Dermatológica Internacional, Madrid, Spain" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Estructuras pigmentadas periféricas de morfología similar a las espículas del SARS-CoV-2 como hallazgo dermatoscópico sugerente de nevo displasico y melanoma incipiente" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 822 "Ancho" => 601 "Tamanyo" => 180461 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Colored transmission electron micrograph showing a SARS-CoV-2 particle isolated from a patient with COVID-19 in the United Kingdom. ©National Infection Service, United Kingdom/Science Photo Library/agefotostock.</p> <p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Note the characteristic outward projecting spikes or protuberances on the surface and the markedly irregular rim and somewhat heterogeneous morphology.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Case Report</span><p id="par0005" class="elsevierStylePara elsevierViewall">The journal <span class="elsevierStyleItalic">Nature</span><a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> recently published an article featuring an image (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>) that immediately caught our attention. If the image was shown in a Rorschach test, a virologist would probably say “coronavirus”, but a dermatologist trained in dermoscopy might well say “a growing melanocytic nevus” or even “melanoma”.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0010" class="elsevierStylePara elsevierViewall">Several aspects of the image reminded us of dermoscopic features we have seen in dysplastic melanocytic nevi and incipient melanomas (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>).</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">What Is Your Diagnosis?</span><p id="par0015" class="elsevierStylePara elsevierViewall">Dermoscopy reveals markedly irregular, large polymorphous peripheral structures, often long in shape and with an angulated rim, similar to the spike proteins of the virus particle in the electron micrograph in <a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>. These features are indicative of a growing atypical melanocytic lesion (dysplastic nevus or incipient melanoma).</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Comment</span><p id="par0020" class="elsevierStylePara elsevierViewall">Zalaudek et al.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> described the presence and significance of peripheral globules in melanocytic lesions more than a decade ago. These globules, which frequently project outwards from the silhouette of the lesion, and sometimes appear to be disconnected, usually indicate active growth.<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">3,4</span></a> Many expanding junctional or compound nevi have a peripheral rim of pigmented globules, which are also common in the most active growth phase of Spitz or Reed nevi.<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">Peripheral globules are occasionally seen in melanoma. In a recent dermoscopic study of the morphology and distribution of peripheral globules in melanocytic lesions, Reiter et al.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> suggested that lesions with asymmetrically distributed globules or globules with varying shapes, sizes, and colors should be biopsied or closely monitored–especially pigmented lesions on the extremities—as they may be signs of an incipient melanoma.</p><p id="par0030" class="elsevierStylePara elsevierViewall">Reiter et al.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> did not include lesions with pseudopods in their study. While pseudopods are also round or oval structures that project outwards from the edge of lesions, they are not <span class="elsevierStyleItalic">globules</span> in the strict sense of the word (the last edition of the Merriam-Webster dictionary defines globule as "a tiny globe or ball especially of a liquid"). Similarly, we do not believe that the structures shown in <a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>—long, polymorphous, pigmented structures, some with an angulated rim—can be described as peripheral globules. Strictly speaking thus, they should not be called <span class="elsevierStyleItalic">globules</span>, nor attributed the same biologic or diagnostic significance as classic peripheral pigmented globules in melanocytic lesions.<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2–5</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">In our experience, these highly irregular pigmented peripheral structures are rare and are neither globules nor pseudopods. We have recently seen several cases of severely dysplastic melanocytic nevi and incipient melanomas in which the most distinctive and suspicious finding was a peripheral ring (sometimes incomplete) featuring structures of this type (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>).</p><p id="par0040" class="elsevierStylePara elsevierViewall">In light of the electron micrograph shown in <a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a> and the fact that we have described these dermoscopic features during the COVID-19 pandemic, we have decided to call them <span class="elsevierStyleItalic">SARS-CoV-2 spike-like pigmented peripheral structures</span>. We believe that the morphologic similarities between the viral spike proteins and these structures are clearly depicted in <a class="elsevierStyleCrossRefs" href="#fig0005">Figs. 1 and 2</a>. We do not believe that their biologic significance or diagnostic value should be likened to those of classic pigmented peripheral globules, although further studies are warranted to confirm their biological and prognostic significance.</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Conflicts of interest</span><p id="par0045" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflicts of interest in relation to the content of this article.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:5 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Case Report" ] 1 => array:2 [ "identificador" => "sec0010" "titulo" => "What Is Your Diagnosis?" ] 2 => array:2 [ "identificador" => "sec0015" "titulo" => "Comment" ] 3 => array:2 [ "identificador" => "sec0020" "titulo" => "Conflicts of interest" ] 4 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Martin-Gorgojo A, Ramírez-Bellver JL, Ruiz-Rodríguez R, Pizarro Á. Estructuras pigmentadas periféricas de morfología similar a las espículas del SARS-CoV-2 como hallazgo dermatoscópico sugerente de nevo displasico y melanoma incipiente. Actas Dermosifiliogr. 2022;113:72–73.</p>" ] ] "multimedia" => array:2 [ 0 => array:8 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 822 "Ancho" => 601 "Tamanyo" => 180461 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Colored transmission electron micrograph showing a SARS-CoV-2 particle isolated from a patient with COVID-19 in the United Kingdom. ©National Infection Service, United Kingdom/Science Photo Library/agefotostock.</p> <p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Note the characteristic outward projecting spikes or protuberances on the surface and the markedly irregular rim and somewhat heterogeneous morphology.</p>" ] ] 1 => array:8 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1327 "Ancho" => 1587 "Tamanyo" => 206102 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0010" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Polarized light dermoscopic images.</p> <p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Lesions with large pigmented peripheral structures and an irregular morphology, similar to SARS-CoV-2 protein spikes. Detailed image of different areas of the lesions are shown in the panels underneath. A, C, Lower right corner. B, Right edge.</p> <p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">The histopathologic diagnoses were dysplastic nevus (A), melanoma in situ (B), and superficial spreading melanoma (C).</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:6 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "COVID and 2020: an extraordinary year for science" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "E. Callaway" 1 => "H. Ledford" 2 => "G. Viglione" 3 => "T. Watson" 4 => "A. Witze" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1038/d41586-020-03437-4" "Revista" => array:6 [ "tituloSerie" => "Nature." 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| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 16 | 14 | 30 |
| 2024 October | 137 | 71 | 208 |
| 2024 September | 146 | 72 | 218 |
| 2024 August | 158 | 62 | 220 |
| 2024 July | 134 | 57 | 191 |
| 2024 June | 133 | 70 | 203 |
| 2024 May | 116 | 50 | 166 |
| 2024 April | 112 | 51 | 163 |
| 2024 March | 127 | 53 | 180 |
| 2024 February | 108 | 51 | 159 |
| 2024 January | 126 | 55 | 181 |
| 2023 December | 88 | 27 | 115 |
| 2023 November | 143 | 38 | 181 |
| 2023 October | 111 | 36 | 147 |
| 2023 September | 106 | 36 | 142 |
| 2023 August | 112 | 23 | 135 |
| 2023 July | 152 | 48 | 200 |
| 2023 June | 104 | 30 | 134 |
| 2023 May | 139 | 22 | 161 |
| 2023 April | 61 | 30 | 91 |
| 2023 March | 98 | 29 | 127 |
| 2023 February | 94 | 32 | 126 |
| 2023 January | 94 | 51 | 145 |
| 2022 December | 95 | 53 | 148 |
| 2022 November | 68 | 49 | 117 |
| 2022 October | 90 | 46 | 136 |
| 2022 September | 92 | 58 | 150 |
| 2022 August | 96 | 90 | 186 |
| 2022 July | 102 | 63 | 165 |
| 2022 June | 93 | 34 | 127 |
| 2022 May | 113 | 55 | 168 |
| 2022 April | 153 | 45 | 198 |
| 2022 March | 213 | 85 | 298 |
| 2022 February | 145 | 50 | 195 |
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