Enlarging melanocytic lesions with peripheral globular pattern: a dermoscopic and confocal microscopy study

Area of Science:

• Dermatology
• Dermoscopy
• Reflectance Confocal Microscopy (RCM)

Background:

• Enlarging melanocytic lesions with peripheral globular pattern (EMLPGP) pose a diagnostic challenge in dermoscopy.
• These lesions can be mistaken for melanoma, leading to unnecessary excisions.
• Accurate differentiation is crucial for appropriate clinical management.

Purpose of the Study:

• To evaluate the diagnostic significance of EMLPGP.
• To assess the utility of dermoscopy and RCM in managing EMLPGP.
• To improve the clinical management of this specific subtype of melanocytic lesions.

Main Methods:

• 135 EMLPGP were recruited and excised based on dermoscopic features.
• Expert dermoscopic review was performed blinded to histology.
• A subgroup of 63 lesions underwent RCM and expert review.

Main Results:

• Histology revealed 116 nevi (86%) and 19 melanomas (14%).
• Small peripheral globules on dermoscopy were significant (78.5%), but other features were not predictive.
• RCM identified atypical cytology and irregular architecture in 100% of melanomas.

Conclusions:

• EMLPGPs are frequently benign and can lead to over-excision, particularly in high-risk patients.
• Dermoscopic evaluation should consider overall features, not just peripheral globules.
• RCM aids in detecting cyto-architectural atypia, optimizing the reduction of benign lesion excisions when combined with dermoscopy.