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Journal of the American Academy of Dermatology
Volume 74, n° 6
pages 1107-1113 (juin 2016)
Doi : 10.1016/j.jaad.2016.01.002
accepted : 1 January 2016
Original Articles

The utility of dermoscopy-guided histologic sectioning for the diagnosis of melanocytic lesions: A case-control study
 

Emily A. Merkel, BA a, Sapna M. Amin, MD a, Christina Y. Lee, BA a, Alfred W. Rademaker, PhD b, Pedram Yazdan, MD a, Mary C. Martini, MD a, Joan Guitart, MD a, Pedram Gerami, MD a,
a Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois 
b Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois 

Reprint requests: Pedram Gerami, MD, Department of Dermatology, Northwestern University, 676 N Saint Clair St, Suite 1765, Chicago, IL 60611.Department of DermatologyNorthwestern University676 N Saint Clair StSuite 1765ChicagoIL60611
Abstract
Background

Dermoscopy allows for visualization of morphologic structures beyond the epidermis, including features that may indicate early malignant transformation. However, dermoscopic features are rarely considered during routine histologic sectioning, and areas of clinical concern may be missed during microscopic evaluation.

Objective

We assessed the diagnostic impact of a dermoscopy-guided micropunch score for the evaluation of melanocytic lesions.

Methods

In this case-control study, we evaluated 150 scored melanocytic lesions. Original tissue specimens were reprocessed to create a control group, in which a new score was introduced elsewhere in the lesion to guide an alternative plane of section. Slides were reviewed in a randomized, double-blinded manner to assess histologic features and render a diagnosis. Dermoscopy was also reviewed.

Results

The proportion of cases with a higher grade in the original, dermoscopy-guided section was statistically significant. Four invasive melanomas were exclusively identified using the scoring protocol. The presence of regression structures, negative pigment network, radial streaming or pseudopods, and irregular blotches were highly specific for a higher diagnostic grade.

Limitations

This study is retrospective and reprocessing tissue does not perfectly mimic routine sectioning.

Conclusion

Dermoscopy can identify important, histologically high-grade areas, and this information can be used to optimize the sectioning of melanocytic neoplasms.

The full text of this article is available in PDF format.

Key words : biopsy, dermoscopy, diagnosis, histology, melanocytic neoplasms, melanoma



 Ms Merkel and Dr Amin contributed equally to this article.
 Supported by the IDP Foundation.
 Disclosure: Dr Rademaker served on the advisory board of Georgetown University Cancer Center, as an instructor for the American Association of Cancer Research, and as a consultant for the National Institutes of Health and Journal of the American Medical Association and received honoraria for this. Dr Martini served on the advisory board of Dove-Unilever and received honoraria for this. Dr Gerami served as a consultant to Castle Biosciences Inc, Myriad Genetics, and DermTech Inc, and received honoraria for this. Ms Merkel, Dr Amin, Ms Lee, Dr Yazdan, and Dr Guitart have no conflicts of interest to declare.



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