|Year : 2019 | Volume
| Issue : 2 | Page : 109-112
Dermoscopy of acral lentiginous melanoma in an Indian patient
Vrutika H Shah1, Kinjal D Rambhia2, Jayesh I Mukhi3, Rajesh P Singh4
1 Department of Dermatology, Venereology, and Leprosy, Seth G. S. Medical College and K. E. M. Hospital, Parel, India
2 Department of Dermatology, Venereology, and Leprosy, HBTMC and Dr. R. N. Cooper Hospital, Juhu, Mumbai, India
3 Department of Dermatology-Venereology-Leprosy, Government Medical college and Hospital, Nagpur, India
4 Department of Dermatology, Venereology and Leprosy, Government Medical College and Hospital, Nagpur, Maharashtra, India
|Date of Web Publication||19-Dec-2019|
Kinjal D Rambhia
Department of Dermatology, Venereology, and Leprosy, HBTMC and Dr. R. N. Cooper Hospital, Juhu, Mumbai, Maharashtra
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Shah VH, Rambhia KD, Mukhi JI, Singh RP. Dermoscopy of acral lentiginous melanoma in an Indian patient. Pigment Int 2019;6:109-12
A 52-year-old man presented with an asymptomatic irregular pigmented lesion on right sole since 2 years. Cutaneous examination revealed a single, ill-defined, 5 cm × 4 cm, variegated colored plaque with irregular borders and rough surface on the right sole [Figure 1]. Regional lymphadenopathy was absent.
|Figure 1 Ill-defined variegated colored plaque with irregular borders on the right sole.|
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Dermoscopy performed with eScope Oitez (magnification 40×) highlighted variation in color (ranging from light brown to dark brown, jet black, and white) with pseudopods and black dots in the ridges [Figure 2]a, intermittent brown–black pigment globules and streaks “black pepper grains” in white structureless area [Figure 2]b, parallel ridge pattern (PRP) with pseudopods and bluish-white veil [Figure 2]c, and white depigmented structureless area with pigmented dots parallel to furrows [Figure 2]d.
|Figure 2 (a) White, blue, red, and yellow arrows showing variation in color as dark brown, light brown, white, and jet black, respectively, and white star and yellow star representing pseudopods and black dots in the ridges, respectively. (b) Red arrow showing black pepper grains in white structureless area as shown by yellow arrow. (c) Yellow arrow pointing to parallel ridge pattern, red arrow pointing to pseudopods, and blue arrow shows bluish-white veil. (d) Red, yellow, and blue arrows show white depigmented structureless area, with pigmented dots and furrows.|
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Histopathology revealed lentiginous proliferation of melanocytes at the dermoepidermal junction and papillary dermis and dermal invasion of malignant melanocytes [Figure 3]. Immunohistochemistry of the skin biopsy sample revealed S-100 and HMB-45 positivity. Based on the above findings, a diagnosis of acral lentiginous melanoma (ALM) was made.
|Figure 3 Lentiginous proliferation of melanocytes at the dermoepidermal junction and papillary dermis, dermal invasion of malignant melanocytes (hematoxylin and eosin, 4× and 10×).|
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Acral volar skin is the most common site of malignant melanoma in Asian population. Acral lesions include the lesions on the palms, soles, volar surfaces of fingers and toes, and ungual (nail matrix and bed) regions. The acral skin is anatomically and histologically unique in that it is characterized by a thick, compact cornified layer and the presence of dermatoglyphics, consisting of ridges and furrows (sulci) that run on the surface in a parallel fashion and form loops, whorls, and arches in highly individualized patterns with pigment deposition along ridges and furrows creating particular dermoscopic patterns exclusive to these sites., Dermoscopy is useful in evaluating pigmented lesions on acral volar skin because dermoscopic patterns detected in pigmented lesions affecting this unique anatomic site are easy to interpret and help in early diagnosis of melanoma [Table 1]. ALM is a rare clinicopathologic variant. Classical lesion includes large macular lentiginous pigmented area around an invasive raised tumor. Characteristic dermoscopic findings include PRP (specificity 99% and negative predictive value 97.7%) and irregular diffuse pigmentation (specificity 96.6% and negative predictive value 97.5%). [Table 2] enumerates other dermoscopic signs in melanoma with their significance.,,, ALM dermoscopic features differ from those observed in nonacral skin and similar to thin amelanotic melanomas on nonglabrous skin, only dotted vessels are seen under dermoscopy. Vascular PRP (VPRP) is an important new alerting sign for early diagnosis of ALM but in pigmented ALM, melanin obscures the increased vascularization leading to the PRP pattern. VPRP is seen as erythema and dotted vessels on the ridges, along the crista intermedia areas. Thus, VPRP is best seen in hypopigmented melanomas, whereby PRP in the lightly pigmented and VPRP in the amelanotic areas can both be seen. A three-step diagnostic algorithm given by Koga and Saida suggests that an acral lesion should first be evaluated for PRP and if no PRP is seen, the lesion should then be checked for any of the three typical dermoscopic patterns seen in benign acral nevi, namely, parallel furrow pattern, lattice-like pattern, and fibrillar pattern. As per Tuma et al., individuals with skin type V/VI have fewer melanocytic lesions than those with skin type I/II, and the acquired melanocytic nevi in the skin type V/VI group are associated with the reticular pattern with a tendency toward central hyperpigmentation that is a distinct dermoscopic pattern than those with skin type I/II. Benign lesion-associated patterns are not uncommon in ALM but are almost always associated with other features, and therefore, the entire surface of the lesion must be examined. Thus, dermoscopy is a reliable tool for diagnosis of ALM and helps in early diagnosis of the lesion with better clinical outcome.
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[Figure 1], [Figure 2], [Figure 3]
[Table 1], [Table 2]