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Letter to the Editor
Transverse-section Histology for Parallel-Ridge Pattern
Sección histological horizontal para el patron de la cresta
D. Torchiaa,b
a Department of Experimental Pathology & Oncology, University of Florence, Florence, Italy
b Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, FL, USA
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    "textoCompleto" => "<span class="elsevierStyleSections"><p class="elsevierStylePara elsevierViewall">In a recent issue of <span class="elsevierStyleItalic">Actas Dermo-Sifiliogr&#225;ficas</span> Bl&#225;zquez et al raise the issue on the opportunity to analyse skin biopsies of acral pigmented lesions featuring a parallel-ridge pattern &#40;PRP&#41; after cutting them perpendicularly to the skin markings so that cristae profundae intermediae are included for sure in the tissue section&#46;<a class="elsevierStyleCrossRef" href="#bib1"><span class="elsevierStyleSup">1</span></a> The Authors conclude that &#8220;diagnosis of some suspect pigmented lesions is rendered impossible by the low cellularity of the sample&#46; In such cases&#44; the use of molecular biology techniques would be advisable to detect chromosomal abnormalities associated with acrolentiginous melanoma &#40;&#8230;&#41;&#8221;&#46;<a class="elsevierStyleCrossRef" href="#bib1"><span class="elsevierStyleSup">1</span></a></p><p class="elsevierStylePara elsevierViewall">I wish to point out that transverse-section histology is a cheap and reliable tool to perform dermatoscopic-histologic correlations of acral pigmented lesions as plans of tissue sectioning are parallel to the skin surface and therefore to dermatoscopic visualization of lesions&#46;<a class="elsevierStyleCrossRefs" href="#bib2"><span class="elsevierStyleSup">2&#44;3</span></a> First&#44; transverse-section histology allows a quick&#44; low-magnification scan of the whole excised specimen&#46; Then&#44; higher magnification and analysis of deeper sections of key or &#8220;suspicious&#8221; dermatoscopic areas achieve and accurate and unambiguous localization of microanatomical structures&#46; Namely&#44; eccrine ducts are cut perpendicularly to their major axis and therefore appear as round or ovalar sections&#46; Epidermal areas containing rows of epidermal ducts are the cristae profundae intermediae&#44; which can be searched thoroughly for atypical&#47;malignant cells and other features &#40;for example melanin columns as a key of benignity&#41; from the overlying corneum till the underlying dermoepidermal junction and dermis&#46; The apparent issue of calculating tumor thickness can be overcome by summing the thickness of all sections overlying the deepest one at which malignant cells are still detected&#46;</p><p class="elsevierStylePara elsevierViewall">In view of these considerations&#44; I propose the following diagnostic iter for acral pigmented lesions featuring a PRP&#58; a&#41; physical examination &#40;possibly with the &#8220;furrow-ink test&#8221;&#46;<a class="elsevierStyleCrossRef" href="#bib4"><span class="elsevierStyleSup">4</span></a>&#41;&#59; b&#41; dermatoscopy&#59; c&#41; wide excisional biopsy&#59; d&#41; split of the specimen into two halves obtained with a cut which is parallel to the skin markings&#59; e&#41; histological examination of half-lesion with sections cut perpendicularly to the skin markings&#46; If no findings of melanoma are present&#44; then f&#41; the remaining half of the specimen should be analyzed after transverse sectioning&#46;</p><p class="elsevierStylePara elsevierViewall">It is worth reaffirming here&#44; though&#44; that the specificity of PRP as a marker of acral lentiginous melanoma is very high<a class="elsevierStyleCrossRef" href="#bib5"><span class="elsevierStyleSup">5</span></a> and that only a handful of PRP-featuring&#44; benign lesions &#40;either pigmented or nonpigmented&#41; have been reported&#46;<a class="elsevierStyleCrossRefs" href="#bib5"><span class="elsevierStyleSup">5&#8211;8</span></a> Therefore every lesion showing a PRP should be managed as a melanoma unless top-qualified professionals decide otherwise&#46;</p></span>"
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ISSN: 00017310
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