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Title: Application assessment of an algorithmic method based on pattern analysis in diagnosing conjunctival pigmented lesions
Abstract:
Aims of the paper This study analysed the prevalence of the characteristics evaluated in dermatoscopy for melanocytic lesions of the conjunctiva with various degrees of malignancy. This work also aimed to develop an algorithm allowing the differentiation between conjunctival melanoma and other melanocytic lesions of the conjunctiva, on the basis of a dermatoscopic examination. We performed retrospective clinical and histopathological analysis of conjunctival lesions surgically treated during one year in our institution in correlation with the interview data, with special regard to the practical approach through the division into pigmented and amelanotic lesion with setting the probability of their attribution to benign, pre-malignant and malignant ones. Material and Methodology A total of 160 conjunctival pigmented lesions (40 naevi, 40 PAM without atypia, 40 PAM with atypia, 40 melanomas) were studied. Each lesion was scored using dermatoscopic patterns and the clues of malignancy described by Kittler. Also, the Authors’ own clues were added to the evaluation (black dots occuring in any parts of the lesion, feeder vessels and cysts) All 305 patients (164 men, 141 women) who underwent surgical excision of conjunctival tumors in 2017 at the Department of Ophthalmology and Ocular Oncology Jagiellonian University Medical College in Krakow were analyzed. ; Color photographs of lesions and the histopathological result were evaluated. Results In melanomas, the following characteristics were identified: asymmetry of the pattern and colour, larger average number of colours, the presence of grey colour, structureless area, polymorphic vessels and feeder vessels. A pattern of black dots and a black colour was typical of malignant lesions and pre-cancerous (premalignant) lesions - primary acquired melanosis (PAM) with atypia. Cysts were observed only in the group of naevi. On the basis of modified dermatoscopic criteria, an algorithm was generated consisting of an assessment of the presence of 9 suspicious characteristics, e.g. more than two colours, colour asymmetry, pattern asymmetry, vascular polymorphism, presence of short vessels, linear vascular pattern, the presence of a peripheral structureless area (in any color axcept the conjunctiva), the presence of a grey structureless area and black dots in any part of the lesion. The presence of any of these characteristics scores 1 point. If a melanocytic lesion scores ≥3 points, the probability of diagnosing melanoma is on the level of p>0.001 Among 305 conjunctival tumors excised in one year, pigmented ones were noted in 190 (62.3%) cases, and amelanotic in 115 (37.7%). Histopathological examination confirmed the presence of benign lesions in 153 (80.5%) in th ; e first group and 62 (53.9%) in the second. In 6 (2.0%) cases the infiltration occurred at the scar site after other surgical procedures (granulomas or benign lymphocytic infiltration). The remaining 35 (11.4%) cases were a local recurrence after previous conjunctival tumor resection. The recurrence tendency was most frequently characterized by tumors described in histopathology as melanocytic cancerous and precancerous. Lesions that have increased significantly before excision and observed less than a year more often showed malignant or precancerous nature. In patients with malignant conjunctival tumors, malignancies of other organs were more common (18.5%) than in patients with benign and pre-cancerous lesions (6.5%). Conclusions The patterns evaluated with dermatoscopy are present in pigmented lesions of the conjunctiva. There are, however, some characteristics which allow differentiation between melanoma, naevus and melanosis and also between PAM. The use of the proposed algorithm, based on modified dermatoscopic characteristics, may be a valuable tool for the diagnosis of conjunctival melanoma. In the case of conjunctival tumors, both the clinical examination and carefully collected patient’s history can be helpful in the establishing the appropriate, initial diagnosis and making optimal therapeutic decisions.
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Last modified:
Jan 2, 2024
In our library since:
Apr 8, 2022
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http://dl.cm-uj.krakow.pl:8080/publication/4637
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| Edition name | Date |
|---|---|
| ZB-135083 | Jan 2, 2024 |
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