A case of a superficial spreading melanoma in situ diagnosed via digital dermoscopic monitoring with high dynamic range conversion.
Bottom Line: The macule, which showed complete symmetry and a typical network, was tentatively diagnosed as a Clark nevus; a 6-month follow-up was recommended, and the patient returned 7 months later.At this point, evidence-based monitoring would have led to excision but the decision was made to continue monitoring.Owing to poor compliance, the patient went another 2 years without follow-up.
Affiliation: Sato Dermatology Clinic, Tokyo, Japan.
A 48-year-old woman presented with a 3 mm, pigmented macule at her first visit to our clinic. The macule, which showed complete symmetry and a typical network, was tentatively diagnosed as a Clark nevus; a 6-month follow-up was recommended, and the patient returned 7 months later. At the second visit, the lesion had enlarged to a diameter of 5 mm, and dermoscopy revealed that it had maintained its typical pigment network. At this point, evidence-based monitoring would have led to excision but the decision was made to continue monitoring. Owing to poor compliance, the patient went another 2 years without follow-up. When we assess small lesions, such as this, the usefulness of dermoscopy is apparent. Additionally, we examined the benefits and drawbacks of high dynamic range (HDR) conversion of the dermoscopy images and their helpfulness for inspecting small lesions. Although the delicate structures present in the lesion can be recognized by a dermoscopy expert and HDR image conversion has a capacity to highlight important structures, there is also a risk that HDR image conversion may mask some of the structural changes. However, a comparison of the original dermoscopy images with the HDR-converted images provides newly trained dermoscopists the opportunity to recognize new findings and to distinguish the differences in the findings between both the types of images. Therefore, such comparisons might be useful for obtaining an accurate diagnosis by using dermoscopy and HDR image conversion.
No MeSH data available.
Related in: MedlinePlus
Mentions: A 48-year-old Japanese woman presented with a 6-month history of a pigmented macule on her left chest. Her family history was unremarkable, but her medical history indicated the excision of a facial basal cell carcinoma 3 years earlier. A physical examination during the initial visit showed a flat, pigmented 3 mm macule on the patient’s left chest. Dermoscopy revealed a typical pigment network at the periphery, with structureless, dark-brown pigmentation in the center (Figure 1A). HDR conversion of the dermoscopic image showed the pigment network more clearly (Figure 1B). The lesion demonstrated complete symmetry in both color and structure, but was darker in the center and paler at the periphery. Therefore, the macule was tentatively diagnosed as a Clark nevus, and a 6-month follow-up was recommended. When the patient presented 7 months later, the lesion had enlarged to 5 mm diameter. Dermoscopic examination of the lesion revealed that it still had a typical pigment network at the periphery as well as structureless, dark-brown, central pigmentation (Figure 2A). HDR conversion of the dermoscopy image also showed the entire pigment network (Figure 2B). There were no obvious findings suggestive of a melanoma apart from the fact that the lesion had more than doubled in size. This would have lead to excision according to evidence based guidelines for short-term monitoring, but in fact a decision was made to continue monitoring for a further 6 months. However, the patient did not present for a follow-up examination for 2 years. At the time of her third clinical visit, the patient’s lesion had further enlarged to 7 mm in diameter (Figure 3A–C). Dermoscopy revealed an atypical pigment network with multifocal thickening of the mesh, color asymmetry, and the presence of bluish-white structures. The HDR conversion continued to reveal the entire pigment network, but demonstrated multifocal darkening and thickening of the mesh on this occasion. These findings were highly suggestive of a melanoma, and the patient was advised to undergo a complete excision of the lesion. The patient was referred to the Department of Dermatology, Tokyo Women’s Medical University Medical Center East, Tokyo, Japan for further assessment. The lesion was excised with a 3 mm margin, and a histological diagnosis of an in situ superficial spreading melanoma was established.
No MeSH data available.