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Melanocytic Lesions with Peripheral Globules: Proposal of an Integrated Management Algorithm
Simone Cappilli1,2, Simone Ribero3, Luigi Cornacchia1,2
1UOC di Dermatologia, Dipartimento di Scienze Mediche e Chirurgiche, Fondazione Policlinico Universitario A. Gemelli - IRCCS, Rome, Italy.
Dermatology Practical & Conceptual
|March 9, 2023
Summary
Melanocytic lesions with peripheral globules (MLPGs) are common in youth but can indicate melanoma in adults, especially those over 55. An age-stratified algorithm helps differentiate benign MLPGs from melanoma.
Area of Science:
- Dermatology
- Oncology
- Dermoscopy
Background:
- Peripheral rim of globules in melanocytic lesions (MLPGs) is a common sign of horizontal growth in nevi, particularly in younger individuals.
- MLPGs in adults warrant increased attention as melanoma can rarely present with this feature.
- Current management guidelines for MLPGs, especially in adults, are lacking a risk-stratified approach.
Purpose of the Study:
- To synthesize existing knowledge regarding MLPGs.
- To develop an integrated management algorithm for MLPGs, stratified by age group.
Main Methods:
- A narrative review of published literature on MLPGs was performed.
- Analysis focused on distinguishing clinical, dermoscopic, and confocal microscopy features differentiating melanoma from benign nevi within MLPGs.
Main Results:
- The risk of melanoma in MLPGs increases with age, particularly over 55, and is higher on extremities, head/neck, and for single, asymmetrical lesions ≥6 mm.
- Dermoscopic indicators of melanoma include atypical peripheral globules, asymmetrical distribution, multiple rims, and reappearance of globules.
- Confocal microscopy findings suggestive of melanoma include pagetoid cells, architectural disarrangement, and atypical dermo-epidermal junction cells.
Conclusions:
- A multi-step, age-stratified management algorithm integrating clinical, dermoscopic, and confocal data is proposed.
- This algorithm aims to improve early melanoma detection.
- The strategy seeks to prevent unnecessary surgical excision of benign nevi.
