Poppyfield bleeding: a new dermatoscopic sign and its histopathological background

Area of Science:

• Dermatopathology
• Oncology
• Vascular Biology

Background:

• Dermatoscopy enhances melanoma diagnostic accuracy.
• An atypical vascular pattern can suggest cutaneous malignant melanoma (CMM).
• The "poppyfield sign" (ruby blood droplets) is observed during dermatoscopy of some CMMs.

Purpose of the Study:

• To investigate the histopathological basis of the poppyfield sign in CMM.
• To correlate the poppyfield sign with specific histopathological features of CMM.

Main Methods:

• Compared 8 CMMs with the poppyfield sign to 8 CMMs without the sign, matched for Breslow thickness.
• Two dermatopathologists independently assessed 16 CMMs for Breslow thickness, Clark level, ulceration, and dilated tumor vessels.
• Lesions were presented in an unsystematic sequence to avoid bias.

Main Results:

• All 8 CMMs exhibiting the poppyfield sign had dilated tumor vessels.
• In contrast, only 25% of CMMs without the poppyfield sign showed dilated tumor vessels (p<0.007).
• Histological ulceration was present in all poppyfield CMMs but none of the non-poppyfield CMMs (p<0.001).

Conclusions:

• The poppyfield bleeding sign is a dermatoscopic indicator of dilated tumor vessels in CMM.
• This sign may reflect increased vascular density and the presence of fragile, primitive vessels in CMM.
• The poppyfield sign can serve as a valuable dermatoscopic clue for CMM diagnosis.