Clinical and dermatoscopic criteria for the preoperative evaluation of cutaneous melanoma thickness,☆☆

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Abstract

Background : Melanoma thickness measured according to the Breslow method is used to determine surgical margin and in patient selection for sentinel node biopsy. Previous studies did not confirm the reliability of melanoma palpability for clinical prediction of tumor thickness. Recently we reported the usefulness of epiluminescence microscopy (dermatoscopy) for in vivo detection of the phases of melanoma progression, as well as tumor depth. Objective : Our purpose was to determine whether the combination of clinical and dermatoscopic criteria could increase the accuracy in preoperative evaluation of melanoma thickness with respect to the clinical elevation and dermatoscopic assessments considered separately. Methods : In a blind retrospective study, 122 cutaneous melanomas were studied to evaluate the presence of several clinical and dermatoscopic criteria and their relation with the histologic thickness. An algorithm of combined criteria was constructed and statistically assessed. Results : Combinations of palpability, diameter of more than 15 mm, pigment network, gray-blue areas, and atypical vascular pattern allowed correct prediction of thickness in 89% of melanomas when categorized in two groups of less than 0.76 mm and more than 0.75 mm thickness, compared with 75% using palpability, and 80% using dermatoscopic criteria. Lower values were obtained in the further subdivision of melanomas into groups of 0.76 to 1.5 mm and more than 1.5 mm thickness. Conclusion : The combination of clinical and dermatoscopic criteria is a more precise guide for the preoperative evaluation of melanoma thickness than either is alone. However, further studies are needed to verify its applicability in establishing the surgical approach to cutaneous melanoma. (J Am Acad Dermatol 1999;40:61-8.)

Section snippets

MATERIAL AND METHODS

A total of 122 patients whose ages ranged from 15 to 76 years (55 men and 67 women) affected by primary cutaneous melanoma were included in this blind retrospective study. According to the degree of clinical elevation, each lesion was categorized as flat, palpable, or nodular (raised > 5 mm). The largest diameter (in millimeters) and the presence or absence of ulceration/erosion were also evaluated and recorded in a database file together with the other clinical data.

Each lesion was then

Evaluation of individual clinical and dermatoscopic criteria

Table I shows the frequency of occurrence of clinical and dermatoscopic criteria in the observed melanomas (M) and classified on the basis of their histologic thickness.

. Frequencies and percentages of clinical and dermatoscopic criteria in all evaluated melanomas (M) and subdivided into different groups of thickness (mm)

CriterionAll lesions (N = 122)M < 0.76 (n = 72)M > 0.75 (n = 50)M 0.76-1.5 (n = 31)M > 1.5 (n = 19)
Palpability
Flat lesion41 (34)41 (57)0 (0)0 (0)0 (0)
Palpable lesion47 (38)29

DISCUSSION

Preoperative evaluation of melanoma thickness by means of clinical elevation has been the object of previous studies. Funk et al21 and Kopf et al5 demonstrated the direct correlation existing between palpability and histologic thickness of melanoma. Taylor and Hughes13 reported the possibility of correlating clinical elevation and Breslow thickness with flat, palpable, and nodular melanomas corresponding to histologic thickness of less than 0.76 mm, 0.76 to 1.5 mm, and more than 1.5 mm,

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    Reprint requests: Giuseppe Argenziano, MD, Clinica Dermatologica, Università Federico II, via Pansini 5, 80131 Naples, Italy. E-mail: [email protected]

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