Acral Melanocytic Lesions Under Conventional, Sub-Ultraviolet Reflectance, and Ultraviolet-Induced Fluorescence...

Differentiating benign acral melanocytic lesions (AMLs) from malignant ones remains a diagnostic challenge. While conventional dermoscopy (CD) is widely used, sub-ultraviolet reflectance dermoscopy (sUVRD) and ultraviolet-induced fluorescence dermoscopy (UVFD) may enhance feature visualization. This study compared the visibility scoring of CD, sUVRD, and UVFD in AMLs.

A total of 42 AMLs from 37 patients were retrospectively analyzed, including 22 nevi, 12 melanoma in situ (MIS), and 8 invasive melanomas. Three dermatologists assessed each lesion using CD, sUVRD, and UVFD, scoring 11 features: parallel furrow pattern (PFP), parallel ridge pattern (PRP), fibrillar pattern, dots/clods, radial lines, blue-white structureless area, blotch, scale, ulceration, lesion margins, and eccrine duct openings on a 5-point scale by consensus.

When all lesions were analyzed collectively, CD provided higher scores than UVFD for PFP, PRP, fibrillar pattern, dots/clods, radial lines, blue-white structureless areas, and blotch, and outperformed sUVRD for PRP and blue-white structureless areas. SUVRD better revealed eccrine duct openings. Scale, ulceration, and lesion margins were consistently well visualized across all three modalities. In subgroup analyses, CD scores were significantly higher than UVFD scores for PFP, fibrillar pattern, and dots/clods in nevi; for PRP and dots/clods in MIS; and for PRP, radial lines, blue-white structureless areas, and blotch in invasive melanoma. SUVRD was superior to CD in demonstrating eccrine duct openings in nevi and to UVFD in MIS.

CD remains superior for visualizing key features of AMLs, while sUVRD and UVFD offer complementary strengths that may enhance overall lesion assessment.