Evaluation of selected risk factors an prognostic factors for in diagnostic imagining techniques with the use of viderodermoscopy and reflectance confocal microscopy in comparison to histopathological examination in patients with cutaneous melanomas


Podolec, Katarzyna


melanoma ; dermoscopy ; reflectance confocal microscopy


Aim: The aim of our study was to determine and assess the prognostic value of dermoscopic and reflectance confocal microscopy (RCM) evaluation of cutaneous melanoma. The assessment was carried out by detailed examination of the relationship between the presence of different dermoscopic structures and the grade of melanomas, by testing predictive value of the dominant dermoscopic pattern in the group of patients diagnosed with melanoma and by assessment of diagnostic accuracy of RCM in the lesions meeting the dermoscopic criteria for melanoma diagnosis. Material and methods: The studies were conducted at the Dermatology Department of the Jagiellonian University Medical College in Krakow, Poland. Heine Delta 20/ Heine Delta 20 Plus/ Heine Delta 20 T (Heine Optotechnik) handheld dermoscopes were used in the study as well as Fotofinder videodermoscope (TeachScreen GmbH, Bad Birnbach, Germany) and Vivascope 1500 reflectance confocal microscope (MAVIG GmbH, Munich, Germany). The tests were conducted independently by 2 dermatologists with the minimum of 6 years of experience in general dermatology and dermoscopy. In order to objectify the assessments, the results of histopathological examinations were blinded to evaluators. Results: Pseudopods and multicomponent pattern in dermoscopy were statistically more prevalent in invasive melanomas in comparison to in situ melanomas; regres ; sion structures were more prevalent in tumors ≥1mm at Breslow Scale; atypical blood vessels and nodules were more specific for invasive melanomas with mitotic index ≥1 and ulceration present in histopathological examination. Assessing the relation between dermoscopic structures and location of primary tumor, we have shown that pseudopods were more commonly observed in melanomas localized on the lower extremities and atypical pigment network on the lower extremities and the trunk. Furthermore, the presence of atypical blood vessels and the complex pattern are statistically more prevalent in female patients. A comparative analysis of the results of reflectance confocal microscopy and dermoscopy applied for skin lesions meeting the dermoscopic diagnostic criteria of melanoma have shown 100% sensitivity and 62% specificity. In the assessment of distinct microscopic structures, the highest specificity was observed for the cerebriform nests (100%). Cell atypia at dermoepidermal junction showed 93,3% sensitivity. In the study assessing predictive the value of the dominant dermoscopic pattern of nevi in the group of patients diagnosed with cutaneous melanoma complex, (multicomponent and two-component) patterns were most prevalent, representing 45.68%. A statistically significant higher prevalence of the dominant pigment network pattern was also found in men when compared to women. Mo ; reover, there was a statistically significant lower prevalence of the pigment network in patients diagnosed with melanomas of the upper limbs and a higher prevalence of dominant homogenous pattern in patients diagnosed with melanomas on head and upper limbs. Conclusions: The results of cited/ above-presented studies suggest that identification of some specific dermoscopic structures in a dermoscopic examination of lesions meeting the diagnostic criteria of melanoma may indicate severity of the disease. The use of the reflectance confocal microscopy may increase the diagnostic accuracy, resulting in a reduction of the number of false positive diagnoses and unnecessary dermatosurgical procedures. Complex pattern is most commonly observed as dominant in patients diagnosed with melanoma; however, our studies indicate that patients with other dominant dermoscopic patterns should also undergo regular dermoscopic examinations.

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Level of degree:

2 - studia doktoranckie

Degree discipline:

dermatologia ; onkologia

Degree grantor:

Wydział Lekarski


Wojas-Pelc, Anna



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Praca doktorska

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pol; eng

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