The significance of crystalline/chrysalis structures in the diagnosis of melanocytic and nonmelanocytic lesions - 13/07/12
Reprint requests: Ashfaq A. Marghoob, MD, Dermatology Service, Memorial Sloan-Kettering Cancer Center, 160 E 53 St, New York, NY 10022.Abstract |
Background |
Crystalline/chrysalis structures (CS) are white shiny streaks that can only be seen with polarized dermatoscopy.
Objectives |
We sought to estimate the prevalence and assess the clinical significance of CS in melanocytic and nonmelanocytic lesions.
Methods |
This was a prospective observational study in which dermatoscopic assessment of lesions was recorded in consecutive patients examined during a 6-month period. In addition, a data set of biopsy-proven melanomas was retrospectively analyzed.
Results |
In all, 11,225 lesions in 881 patients were prospectively examined. Retrospectively, 229 melanomas imaged with polarized dermatoscopy were analyzed. In the prospective data set, a median of 12.7 lesions (range, 1-54) were evaluated per patient. None of clinically diagnosed Clark nevi (n = 9750, 86.8%) demonstrated CS. Overall, CS were observed in 206 (1.8%) lesions, most commonly dermatofibromas and scars among nonbiopsied lesions. A total of 265 (2.4%) lesions were biopsied, including 20 melanomas and 36 nevi. Among biopsied malignant lesions, CS were most commonly observed in basal cell carcinoma (47.6%) and invasive melanomas (84.6%). Melanomas were more likely to have CS than biopsied nevi (odds ratio = 9.7, 95% confidence interval 2.7-34.1). In the retrospective data set, CS were more commonly observed among invasive melanomas (41%) compared with in situ melanomas (17%) (odds ratio = 3.4, 95% confidence interval 1.9-6.3, P < .001). The prevalence of CS correlated with increased melanoma thickness (P = .001).
Limitations |
Biopsied lesions represent a small percentage of the total number of lesions evaluated.
Conclusion |
Among biopsied malignant lesions, CS are most commonly observed in basal cell carcinoma and invasive melanomas and rarely seen in nevi. In melanoma, CS may reflect increased tumor thickness and progression.
Le texte complet de cet article est disponible en PDF.Key words : basal cell carcinoma, crystalline/chrysalis structures, dermatofibroma, invasive melanoma, matrix remodeling, polarized dermatoscopy
Abbreviations used : BCC, bFGF, CI, CS, DFs, OR, PD, SK
Plan
| Funding sources: None. |
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| Disclosure: Dr Rabinovitz is on advisory boards of EOS and Derm Tech; an investigator for EOS, Lucid, Derm Tech, Scibase, and Galileo; a speaker for EOS, Lucid, 3Gen, LLC, and Derm Tech; and a consultant for EOS, 3Gen, LLC, and Derm Tech. He has received grants from EOS, Lucid, Derm Tech, Scibase, and Galileo; honoraria from EOS, Lucid, and 3Gen, LLC; and equipment from 3Gen, LLC. Drs Balagula, Braun, Dusza, Scope, Mordente, Siamas, and Marghoob, and Ms Liebman have no conflicts of interest to declare. |
Vol 67 - N° 2
P. 194.e1-194.e8 - août 2012 Retour au numéro
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