Clinicopathological, dermoscopic features and circumstances of diagnosis of amelanotic or hypomelanotic melanoma: A prospective multicentric study in the French private medical sector

IF 3.1 4区 医学 Q2 DERMATOLOGY
E. Lorier Roy , J.-Y. Gourhant , C. Derancourt , N. Jouan , A. Dupuy , J.-F. Séi , on behalf of the Fédération Française de Formation Continue en Dermato-Vénéréologie
{"title":"Clinicopathological, dermoscopic features and circumstances of diagnosis of amelanotic or hypomelanotic melanoma: A prospective multicentric study in the French private medical sector","authors":"E. Lorier Roy ,&nbsp;J.-Y. Gourhant ,&nbsp;C. Derancourt ,&nbsp;N. Jouan ,&nbsp;A. Dupuy ,&nbsp;J.-F. Séi ,&nbsp;on behalf of the Fédération Française de Formation Continue en Dermato-Vénéréologie","doi":"10.1016/j.annder.2024.103249","DOIUrl":null,"url":null,"abstract":"<div><h3>Background</h3><p>Amelanotic or hypomelanotic melanomas (AHM) are difficult to diagnose, and are often diagnosed late, with a high Breslow index and a poor prognosis.</p></div><div><h3>Patients and methods</h3><p>A total of 226 volunteer dermatologists consulting in private practice in France completed an online form for each new histologically proven case of melanoma diagnosed at their clinic in 2020. This anonymised survey collected data on the clinical, dermoscopic, and histological features of melanoma, as well as the circumstances of diagnosis and initial management. A group of 145 AHM was single out and compared to the 1503 pigmented melanomas (PM) from the same cohort.</p></div><div><h3>Results</h3><p>1503 pigmented melanomas (PM) and 145 AHM (8.8% of these melanomas) were identified and included. In the AHM group, the mean age at diagnosis was 65 ± 16 years, with no significant difference from the PM control group. AHM were not predominantly on the face and neck area, and there were no differences based on gender. Warning signs (local progression and bleeding) were significantly more frequent in the AHM group than in the PM group. AHM were more frequently ulcerated and nodular, with a higher median Breslow thickness than in the PM group (1.56 vs. 0.5 mm), and mitoses were more frequent. Dermoscopy was widely used and proved useful for distinguishing benign lesions, and for highlighting the vascular polymorphous pattern of malignant lesions. Patients noticed the suspicious lesion themselves in most cases of AHM (73.2%), as opposed to their general practitioner (17.2%) or entourage (9.5%). A total body skin examination enabled detection of 19.3% of AHM and 21.3% of PM where the patient consulted for another lesion, or for an unrelated reason.</p></div><div><h3>Conclusion</h3><p>AHM are difficult to diagnose for the clinician because of the paucity or absence of pigmentary criteria. Knowledge of dermoscopic vascular patterns is critical and could help reduce the median Breslow index of AHM at the time of detection. Self-examination of the skin should be encouraged, and simple algorithms for earlier detection of skin cancers should be promoted among health professionals and the general population.</p></div>","PeriodicalId":7900,"journal":{"name":"Annales De Dermatologie Et De Venereologie","volume":null,"pages":null},"PeriodicalIF":3.1000,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Annales De Dermatologie Et De Venereologie","FirstCategoryId":"3","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S015196382400005X","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"DERMATOLOGY","Score":null,"Total":0}
引用次数: 0

Abstract

Background

Amelanotic or hypomelanotic melanomas (AHM) are difficult to diagnose, and are often diagnosed late, with a high Breslow index and a poor prognosis.

Patients and methods

A total of 226 volunteer dermatologists consulting in private practice in France completed an online form for each new histologically proven case of melanoma diagnosed at their clinic in 2020. This anonymised survey collected data on the clinical, dermoscopic, and histological features of melanoma, as well as the circumstances of diagnosis and initial management. A group of 145 AHM was single out and compared to the 1503 pigmented melanomas (PM) from the same cohort.

Results

1503 pigmented melanomas (PM) and 145 AHM (8.8% of these melanomas) were identified and included. In the AHM group, the mean age at diagnosis was 65 ± 16 years, with no significant difference from the PM control group. AHM were not predominantly on the face and neck area, and there were no differences based on gender. Warning signs (local progression and bleeding) were significantly more frequent in the AHM group than in the PM group. AHM were more frequently ulcerated and nodular, with a higher median Breslow thickness than in the PM group (1.56 vs. 0.5 mm), and mitoses were more frequent. Dermoscopy was widely used and proved useful for distinguishing benign lesions, and for highlighting the vascular polymorphous pattern of malignant lesions. Patients noticed the suspicious lesion themselves in most cases of AHM (73.2%), as opposed to their general practitioner (17.2%) or entourage (9.5%). A total body skin examination enabled detection of 19.3% of AHM and 21.3% of PM where the patient consulted for another lesion, or for an unrelated reason.

Conclusion

AHM are difficult to diagnose for the clinician because of the paucity or absence of pigmentary criteria. Knowledge of dermoscopic vascular patterns is critical and could help reduce the median Breslow index of AHM at the time of detection. Self-examination of the skin should be encouraged, and simple algorithms for earlier detection of skin cancers should be promoted among health professionals and the general population.

黑色素瘤或黑素细胞减少症的临床病理学、皮肤镜特征和诊断情况:法国私立医疗机构的一项前瞻性多中心研究
背景黑色素瘤(AHM)很难诊断,而且往往诊断较晚,布瑞斯勒指数较高,预后较差。患者和方法共有226名法国私人诊所的皮肤科医生志愿者填写了一份在线表格,内容涉及2020年在其诊所诊断的每一例经组织学证实的黑色素瘤新病例。这项匿名调查收集了有关黑色素瘤的临床、皮肤镜检查和组织学特征以及诊断和初步治疗情况的数据。结果 1503 例色素性黑色素瘤(PM)和 145 例 AHM(占黑色素瘤的 8.8%)被确定并纳入调查。在AHM组中,确诊时的平均年龄为65 ± 16岁,与PM对照组无明显差异。AHM并非主要发生在面部和颈部,也没有性别差异。AHM组的预警信号(局部恶化和出血)明显多于PM组。AHM更常见于溃疡和结节,布瑞斯洛厚度中位数高于PM组(1.56毫米对0.5毫米),有丝分裂也更常见。皮肤镜被广泛使用,并被证明有助于区分良性病变,以及突出显示恶性病变的血管多形性模式。大多数 AHM 病例(73.2%)的可疑病变是患者自己发现的,而不是由普通医生(17.2%)或随行人员(9.5%)发现的。通过全身皮肤检查,19.3%的AHM和21.3%的PM被检出,而患者是因其他病变或与此无关的原因就诊的。了解皮肤镜下的血管形态至关重要,有助于降低发现 AHM 时的中位布雷斯罗指数。应鼓励进行皮肤自我检查,并向医疗专业人员和普通民众推广早期发现皮肤癌的简单算法。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
求助全文
约1分钟内获得全文 求助全文
来源期刊
CiteScore
1.40
自引率
0.00%
发文量
70
审稿时长
81 days
期刊介绍: Les Annales de dermatologie sont le rendez-vous mensuel incontournable de toute la dermatologie francophone, grâce à leur comité de rédaction qui assure une sélection rigoureuse des articles selon les normes de l''édition scientifique internationale. Une revue didactique, véritable aide à la pratique médicale quotidienne Pour compléter et enrichir la partie scientifique, la rubrique Formation médicale continue propose aux lecteurs des textes didactiques et interactifs (Cas pour diagnostic, Notes de pharmacovigilance, la Question du praticien, Dermatologie chirurgicale, la Sélection bibliographique du mois...) qui les font bénéficier d''une formation post-universitaire diversifiée et de qualité. La revue consacre également un espace pour la publication de questions des lecteurs auxquelles des experts apportent une réponse.
×
引用
GB/T 7714-2015
复制
MLA
复制
APA
复制
导出至
BibTeX EndNote RefMan NoteFirst NoteExpress
×
提示
您的信息不完整,为了账户安全,请先补充。
现在去补充
×
提示
您因"违规操作"
具体请查看互助需知
我知道了
×
提示
确定
请完成安全验证×
copy
已复制链接
快去分享给好友吧!
我知道了
右上角分享
点击右上角分享
0
联系我们:info@booksci.cn Book学术提供免费学术资源搜索服务,方便国内外学者检索中英文文献。致力于提供最便捷和优质的服务体验。 Copyright © 2023 布克学术 All rights reserved.
京ICP备2023020795号-1
ghs 京公网安备 11010802042870号
Book学术文献互助
Book学术文献互助群
群 号:481959085
Book学术官方微信