Practical Dermoscopy
Prominent Skin Markings: A New Reason to Suspect Melanoma
Líneas cutáneas prominentes: un nuevo criterio de sospecha en lesiones melanocíticas
M. Álvarez-Salafranca
, J. Sánchez-Bernal, M. Ara Martín
Corresponding author
Servicio de Dermatología, Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain
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Destaca la presencia de líneas o surcos prominentes, más claros que el resto de la lesión y que se entrecruzan entre ellos (flecha). Además, se observan vasos puntiformes en las zonas hipopigmentadas (asterisco).</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "M. Álvarez-Salafranca, J. Sánchez-Bernal, M. Ara Martín" "autores" => array:3 [ 0 => array:2 [ "nombre" => "M." "apellidos" => "Álvarez-Salafranca" ] 1 => array:2 [ "nombre" => "J." "apellidos" => "Sánchez-Bernal" ] 2 => array:2 [ "nombre" => "M." 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Ultrasound of the groin showed greatly enlarged lymph nodes with cortical asymmetry and limited vascularization. After treatment with doxycycline 100 mg every 12 hours for 21 days, lymph node enlargement reduced leaving a residual scar.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "J. Magdaleno-Tapial, P. Hernández-Bel, C. Valenzuela-Oñate, M.D. Ocete-Mochon, A. Pérez-Ferriols" "autores" => array:5 [ 0 => array:2 [ "nombre" => "J." "apellidos" => "Magdaleno-Tapial" ] 1 => array:2 [ "nombre" => "P." "apellidos" => "Hernández-Bel" ] 2 => array:2 [ "nombre" => "C." "apellidos" => "Valenzuela-Oñate" ] 3 => array:2 [ "nombre" => "M.D." "apellidos" => "Ocete-Mochon" ] 4 => array:2 [ "nombre" => "A." 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Álvarez-Salafranca, J. Sánchez-Bernal, M. Ara Martín" "autores" => array:3 [ 0 => array:4 [ "nombre" => "M." "apellidos" => "Álvarez-Salafranca" "email" => array:1 [ 0 => "marcialaspn@gmail.com" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "*" "identificador" => "cor0005" ] ] ] 1 => array:2 [ "nombre" => "J." "apellidos" => "Sánchez-Bernal" ] 2 => array:2 [ "nombre" => "M." "apellidos" => "Ara Martín" ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Servicio de Dermatología, Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Líneas cutáneas prominentes: un nuevo criterio de sospecha en lesiones melanocíticas" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 563 "Ancho" => 750 "Tamanyo" => 52499 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0010" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Dermoscopic image showing an irregular pigment network, light brown structureless areas, hypopigmented areas, and sparse irregularly distributed dots. Note the prominent intersecting skin markings paler in color than the rest of the lesion (arrow) and the dotted vessels in the hypopigmented areas (asterisk).</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Case Description</span><p id="par0005" class="elsevierStylePara elsevierViewall">A 64-year-old woman with severe actinic damage presented with a pigmented lesion of recent onset on the external aspect of her left leg. The clinical examination showed an irregular pigmented macule with a lentiginous appearance and measuring 7 mm at its widest point; the surrounding skin showed signs of severe sun damage, with multiple solar lentigines (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>).</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Comment</span><p id="par0010" class="elsevierStylePara elsevierViewall">Polarized light dermoscopy showed a discrete irregular pigment network, light-brown structureless areas, hypopigmented areas, and sparse, irregularly distributed, dots. One particularly remarkable finding was the presence of prominent skin markings in the form of intersecting lines that were paler in color than the rest of the lesion and interrupted other structures. Also visible were dotted vessels in the hypopigmented areas that were more visible than those in the surrounding skin (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>).</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">Considering the clinical context (a flat pigmented lesion of recent onset in a patient with severely sun-damaged skin) and the dermoscopic findings, the lesion was excised. The histopathologic diagnosis was melanoma in situ with a lentiginous growth pattern.</p><p id="par0020" class="elsevierStylePara elsevierViewall">The dermoscopic finding of prominent skin markings was recently described as a powerful diagnostic indicator of melanoma in situ versus atypical nevus, particularly in sun-damaged areas of the skin.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> These markings, which are associated with high levels of interobserver agreement, are intersecting linear furrows, lighter in color than the rest of the lesion. They have been linked in particular to melanoma in situ or melanoma with a low Breslow thickness located on the lower limbs.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">Lallas et al.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> reported that, while less common, prominent skin markings can also be found in other lesions, such as, in order of frequency, Reed nevus, melanocytic nevus, seborrheic keratosis/solar lentigines, Bowen disease, and basal cell carcinoma.</p><p id="par0030" class="elsevierStylePara elsevierViewall">Although the significance of prominent skin markings has generated some controversy,<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> this dermoscopic feature has proven to be a powerful predictor of melanoma after adjustment for sun damage and age in the studies in which it has been described.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> Other more common dermoscopic features associated with melanoma in nonfacial chronically sun-damaged skin are angulated lines, granularity, and groups of atypical dots.<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">The atypical vascular pattern is more common in invasive melanoma than in melanoma in situ.<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> Uniform, regularly distributed, dotted vessels, however, are characteristic of flat lesions, like the one presented in this case.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a></p><p id="par0040" class="elsevierStylePara elsevierViewall">In conclusion, prominent skin markings are a new dermoscopic marker that should raise suspicion in melanocytic lesions and could help increase the early detection of melanoma, particularly in sun-damaged skin.</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Conflicts of Interest</span><p id="par0045" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflicts of interest.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:4 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Case Description" ] 1 => array:2 [ "identificador" => "sec0010" "titulo" => "Comment" ] 2 => array:2 [ "identificador" => "sec0015" "titulo" => "Conflicts of Interest" ] 3 => 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: Álvarez-Salafranca M, Sánchez-Bernal J, Ara Martín M. Líneas cutáneas prominentes: un nuevo criterio de sospecha en lesiones melanocíticas. Actas Dermosifiliogr. 2021;112:451–452.</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" => 564 "Ancho" => 750 "Tamanyo" => 64156 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Irregular pigmented macule measuring 7 mm in a severely sun-damaged area of the left leg.</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" => 563 "Ancho" => 750 "Tamanyo" => 52499 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0010" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Dermoscopic image showing an irregular pigment network, light brown structureless areas, hypopigmented areas, and sparse irregularly distributed dots. Note the prominent intersecting skin markings paler in color than the rest of the lesion (arrow) and the dotted vessels in the hypopigmented areas (asterisk).</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" => "Accuracy of Dermoscopic criteria for the diagnosis of melanoma in situ" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "A. Lallas" 1 => "C. Longo" 2 => "M. Manfredini" 3 => "E. Benati" 4 => "H. Babino" 5 => "C. Chinazzo" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1001/jamadermatol.2017.6447" "Revista" => array:6 [ "tituloSerie" => "JAMA Dermatol" "fecha" => "2018" "volumen" => "154" "paginaInicial" => "414" "paginaFinal" => "419" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/29466542" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0010" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Un covering the diagnostic dermoscopic features of flat melanomas located on the lower limbs" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "S. Bassoli" 1 => "A. Kyrgidis" 2 => "S. Ciardo" 3 => "A. Casari" 4 => "A. Losi" 5 => "B. 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Marghoob" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/bjd.16420" "Revista" => array:6 [ "tituloSerie" => "Br J Dermatol" "fecha" => "2018" "volumen" => "178" "paginaInicial" => "1224" "paginaFinal" => "1225" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/29405262" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0020" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Wide skin markings pattern: melanoma descriptor or patient-related factor?: reply from the authors" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "C. Longo" 1 => "A. Lallas" 2 => "A. Kyrgidis" 3 => "S. Bassoli" 4 => "E. Moscarella" 5 => "G. Pellacani" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/bjd.16430" "Revista" => array:5 [ "tituloSerie" => "Br J Dermatol" "fecha" => "2018" "volumen" => "178" "paginaInicial" => "1226" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/29411876" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0025" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Clinical and dermoscopic characteristics of melanomas on nonfacial chronically sun-damaged skin" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "N. Jaimes" 1 => "A.A. Marghoob" 2 => "H. Rabinovitz" 3 => "R.P. Braun" 4 => "A. Cameron" 5 => "C. 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Jordá" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.ad.2011.11.005" "Revista" => array:7 [ "tituloSerie" => "Actas Dermosifiliogr" "fecha" => "2012" "volumen" => "103" "paginaInicial" => "357" "paginaFinal" => "375" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22463770" "web" => "Medline" ] ] "itemHostRev" => array:3 [ "pii" => "S105230571930062X" "estado" => "S300" "issn" => "10523057" ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/15782190/0000011200000005/v1_202105020833/S1578219021000858/v1_202105020833/en/main.assets" "Apartado" => array:4 [ "identificador" => "19289" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Practical Dermoscopy" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/15782190/0000011200000005/v1_202105020833/S1578219021000858/v1_202105020833/en/main.pdf?idApp=UINPBA000044&text.app=https://actasdermo.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1578219021000858?idApp=UINPBA000044" ]
| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 17 | 6 | 23 |
| 2024 October | 147 | 67 | 214 |
| 2024 September | 126 | 43 | 169 |
| 2024 August | 150 | 65 | 215 |
| 2024 July | 150 | 37 | 187 |
| 2024 June | 147 | 75 | 222 |
| 2024 May | 123 | 58 | 181 |
| 2024 April | 121 | 34 | 155 |
| 2024 March | 125 | 41 | 166 |
| 2024 February | 129 | 42 | 171 |
| 2024 January | 111 | 38 | 149 |
| 2023 December | 78 | 27 | 105 |
| 2023 November | 129 | 33 | 162 |
| 2023 October | 137 | 26 | 163 |
| 2023 September | 123 | 28 | 151 |
| 2023 August | 118 | 32 | 150 |
| 2023 July | 126 | 53 | 179 |
| 2023 June | 132 | 32 | 164 |
| 2023 May | 139 | 33 | 172 |
| 2023 April | 87 | 30 | 117 |
| 2023 March | 104 | 38 | 142 |
| 2023 February | 71 | 26 | 97 |
| 2023 January | 72 | 37 | 109 |
| 2022 December | 90 | 40 | 130 |
| 2022 November | 73 | 41 | 114 |
| 2022 October | 59 | 40 | 99 |
| 2022 September | 63 | 53 | 116 |
| 2022 August | 67 | 56 | 123 |
| 2022 July | 37 | 40 | 77 |
| 2022 June | 26 | 38 | 64 |
| 2022 May | 82 | 51 | 133 |
| 2022 April | 99 | 32 | 131 |
| 2022 March | 89 | 65 | 154 |
| 2022 February | 145 | 39 | 184 |
| 2022 January | 110 | 43 | 153 |
| 2021 December | 77 | 46 | 123 |
| 2021 November | 90 | 48 | 138 |
| 2021 October | 112 | 79 | 191 |
| 2021 September | 87 | 47 | 134 |
| 2021 August | 81 | 40 | 121 |
| 2021 July | 60 | 25 | 85 |
| 2021 June | 73 | 47 | 120 |
| 2021 May | 92 | 63 | 155 |
| 2021 April | 76 | 114 | 190 |
| 2021 March | 74 | 50 | 124 |
| 2021 February | 1 | 2 | 3 |
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