Dermatoscopia práctica
Erythematous Macule on a Photodamaged Back. Dermoscopic Clues for the Identification of Lentiginous Melanoma
Mácula eritematosa en una espalda fotodañada. Claves dermatoscópicas para identificar un melanoma lentiginoso
C. Sarró-Fuente
, R. Gamo-Villegas, U. Floristán-Muruzábal
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Servicio de Dermatología, Hospital Universitario Fundación Alcorcón, Alcorcón, Madrid, Spain
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Note the improvement of the lesions after 6 months of treatment with apremilast 30<span class="elsevierStyleHsp" style=""></span>mg twice a day (C and D).</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "M. Mansilla-Polo, C. Abril-Pérez, M.Á. Navarro-Mira, R. Botella-Estrada" "autores" => array:4 [ 0 => array:2 [ "nombre" => "M." "apellidos" => "Mansilla-Polo" ] 1 => array:2 [ "nombre" => "C." "apellidos" => "Abril-Pérez" ] 2 => array:2 [ "nombre" => "M.Á." "apellidos" => "Navarro-Mira" ] 3 => array:2 [ "nombre" => "R." "apellidos" => "Botella-Estrada" ] ] ] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0001731023004908?idApp=UINPBA000044" "url" => "/00017310/unassign/S0001731023004908/v1_202307180913/en/main.assets" ] "asociados" => array:1 [ 0 => array:17 [ "pii" => "S0001731024004903" "issn" => "00017310" "doi" => "10.1016/j.ad.2024.02.034" "estado" => "S200" "fechaPublicacion" => "2024-07-15" "aid" => "3987" "copyright" => "AEDV" "documento" => "simple-article" "crossmark" => 0 "subdocumento" => "crp" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "es" => array:10 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Dermatoscopia Práctica</span>" "titulo" => "Mácula eritematosa en una espalda fotodañada. Claves dermatoscópicas para identificar un melanoma lentiginoso" "tienePdf" => "es" "tieneTextoCompleto" => "es" "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Erythematous Macule on a Photodamaged Back. Dermoscopic Clues for the Identification of Lentiginous Melanoma" ] ] "contieneTextoCompleto" => array:1 [ "es" => true ] "contienePdf" => array:1 [ "es" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figura 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1102 "Ancho" => 900 "Tamanyo" => 75215 ] ] "descripcion" => array:1 [ "es" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Imagen dermatoscópica. Centro desestructurado eritematoso con una vascularización atípica (flechas negras), un foco de pigmentación excéntrica (triángulo negro) y un retículo típico en la periferia (flecha blanca).</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "C. Sarró-Fuente, R. Gamo-Villegas, U. Floristán-Muruzábal" "autores" => array:3 [ 0 => array:2 [ "nombre" => "C." "apellidos" => "Sarró-Fuente" ] 1 => array:2 [ "nombre" => "R." "apellidos" => "Gamo-Villegas" ] 2 => array:2 [ "nombre" => "U." "apellidos" => "Floristán-Muruzábal" ] ] ] ] ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0001731024004903?idApp=UINPBA000044" "url" => "/00017310/unassign/S0001731024004903/v1_202407150421/es/main.assets" ] ] "en" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Dermatoscopia práctica</span>" "titulo" => " Erythematous Macule on a Photodamaged Back. Dermoscopic Clues for the Identification of Lentiginous Melanoma" "tieneTextoCompleto" => true "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "C. Sarró-Fuente, R. Gamo-Villegas, U. Floristán-Muruzábal" "autores" => array:3 [ 0 => array:4 [ "nombre" => "C." "apellidos" => "Sarró-Fuente" "email" => array:1 [ 0 => "claudia.sarro@salud.madrid.org" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:2 [ "nombre" => "R." "apellidos" => "Gamo-Villegas" ] 2 => array:2 [ "nombre" => "U." "apellidos" => "Floristán-Muruzábal" ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Servicio de Dermatología, Hospital Universitario Fundación Alcorcón, Alcorcón, Madrid, Spain" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Mácula eritematosa en una espalda fotodañada. Claves dermatoscópicas para identificar un melanoma lentiginoso" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 1146 "Ancho" => 2458 "Tamanyo" => 413979 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Confocal microscopy. A) Epidermis with an atypical honeycomb appearance and numerous dendritic cells, many of which are perifollicular in location. B) Disorganized dermoepidermal junction with atypical junctional thickening and abundant atypical cells.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Case presentation</span><p id="par0005" class="elsevierStylePara elsevierViewall">A 48-year-old man with no relevant past medical medical history was examined during regular follow-up in the digital dermoscopy clinic. He exhibited a light brown macule on his right shoulder—measuring 1<span class="elsevierStyleHsp" style=""></span>cm<span class="elsevierStyleSup">2</span> in diameter—without evident changes at the follow-up with digital dermoscopy body mapping (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a><span class="elsevierStyleSup">12</span>). The patient reported having undergone laser hair removal sessions up to 1 year and a half prior to the consultation.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Presentation of the 2 images followed by this question: what is your diagnosis?</span><p id="par0010" class="elsevierStylePara elsevierViewall">Dermoscopy only showed blurred central areas with atypical vascularization and a typical fine reticular pattern at the periphery (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>). What is your diagnosis?</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Commentary</span><p id="par0015" class="elsevierStylePara elsevierViewall">Confocal microscopy of the lesion revealed the presence of epidermis with abundant dendritic cells and a disorganized dermoepidermal junction where atypical cells were also seen (<a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>). Lesion was excised with the histological diagnosis of extrafacial lentigo maligna (LME).</p><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0020" class="elsevierStylePara elsevierViewall">LMEs are lentiginous-pattern melanomas associated with chronic sun damage whose incidence has been on the rise.<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">1–3</span></a> A model of clinical progression and dermoscopic representation of these lesions has been described.<a class="elsevierStyleCrossRefs" href="#bib0040"><span class="elsevierStyleSup">2,4</span></a> The first event is disruption of the reticular pattern, followed by the appearance of blurred areas with surrounding pigment dots and triangular structures, progressing to angled and “zigzag” lines. Finally, the lesion progresses into an almost complete erasure, showing only central atypical vascularization and short white lines.<a class="elsevierStyleCrossRefs" href="#bib0040"><span class="elsevierStyleSup">2,4</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">The greatest diagnostic difficulty occurs in incipient lesions, which retain many areas of typical reticular pattern with minimal reticular distortion, and in more advanced cases, showing an almost complete loss of the reticular pattern, with a preserved peripheral reticular pattern. Back in 2022, we described a case of LME very similar to this one, with the entire lesion almost completely blurred under dermoscopy, with short white lines, atypical vascularization, and a preserved peripheral reticular pattern.<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">5</span></a> Lentigo maligna (<a class="elsevierStyleCrossRef" href="#fig0010">Figure 2</a>) did not exhibit central white lines, only atypical vascularization and a peripheral reticular pattern which confirmed the melanocytic origin of the lesion.</p><p id="par0030" class="elsevierStylePara elsevierViewall">Early detection of lentigo maligna is crucial to prevent its progression to invasive melanoma.<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">6</span></a> Since cases have been reported with very subtle features, we recommend paying special attention to lesions with remnants of a pigmented reticular pattern and central atypical vascularization, with or without short white lines inside.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:4 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Case presentation" ] 1 => array:2 [ "identificador" => "sec0010" "titulo" => "Presentation of the 2 images followed by this question: what is your diagnosis?" ] 2 => array:2 [ "identificador" => "sec0015" "titulo" => "Commentary" ] 3 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "multimedia" => array:3 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1123 "Ancho" => 1500 "Tamanyo" => 212991 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Clinical image. 1cm<span class="elsevierStyleSup">2</span> light brown macule with well-demarcated borders.</p>" ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1836 "Ancho" => 1500 "Tamanyo" => 152379 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Dermoscopic image. Disorganized erythematous center with atypical vascularization (black arrows), an eccentric pigmentation focus (black triangle), and a typical reticular pattern at the periphery (white arrow).</p>" ] ] 2 => array:7 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 1146 "Ancho" => 2458 "Tamanyo" => 413979 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Confocal microscopy. A) Epidermis with an atypical honeycomb appearance and numerous dendritic cells, many of which are perifollicular in location. B) Disorganized dermoepidermal junction with atypical junctional thickening and abundant atypical cells.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:6 [ 0 => array:3 [ "identificador" => "bib0035" "etiqueta" => "1" "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. Rosendahl" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.jaad.2015.02.1117" "Revista" => array:6 [ "tituloSerie" => "J Am Acad Dermatol." "fecha" => "2015" "volumen" => "72" "paginaInicial" => "1027" "paginaFinal" => "1035" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25824275" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0040" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Key dermoscopic signs in the diagnosis and progression of extrafacial lentigo maligna: Evaluation of a series of 41 cases" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "R. Gamo-Villegas" 1 => "A. Pampín-Franco" 2 => "U. Floristán-Murúzabal" 3 => "E. García-Zamora" 4 => "F. Pinedo-Moraleda" 5 => "J.L. López-Estebaranz" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/ajd.13051" "Revista" => array:6 [ "tituloSerie" => "Australas J Dermatol." 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