Melanocytic Lesions With Peripheral Globules: Proposal Of An Integrated Management Algorithm
Introduction: A peripheral rim of globules represents a marker of horizontal growth phase in nevi and is a common feature in children and adolescents. The observation of melanocytic lesion with peripheral globules (MLPG) in adulthood deserve more attention, since a melanoma may exhibits this featur...
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| Vydáno v: | Dermatology practical & conceptual Ročník 13; číslo 1; s. e2023010 |
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| Médium: | Journal Article |
| Jazyk: | angličtina |
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Austria
Mattioli 1885
01.01.2023
Mattioli1885 |
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| ISSN: | 2160-9381, 2160-9381 |
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| Abstract | Introduction: A peripheral rim of globules represents a marker of horizontal growth phase in nevi and is a common feature in children and adolescents. The observation of melanocytic lesion with peripheral globules (MLPG) in adulthood deserve more attention, since a melanoma may exhibits this feature albeit rarely. Risk stratified management recommendations considering a global clinical approach are still missing.
Objectives: To analyze current knowledge on MLPG and propose an integrated management algorithm stratified for age groups.
Methods: We conducted a narrative review of current published data on MPLG, analyzing clinical dermoscopic and confocal distinguishing features of melanoma from bening nevi.
Results: The risk of finding a melanoma when removing a MLPG increases with age especially in people >55 years old and results significantly higher on extremities, head/neck and in case of a single asymmetrical lesion, ≥6 mm in diameter. Dermoscopic features associated to melanoma diagnosis include atypical peripheral globules, asymmetrical distribution, multiple rims as well as globules reappearance after previous loss. In addition, wide blue-grey regression areas, atypical network, eccentric blotches, tan structureless peripheral areas and vascularizationare atypical dermoscopic features. Confocal worrisome findingss are represented by pagetoid cells within the epidermis, architectural disarrangement and atypical cells of the dermo-epidermal junction with irregular peripheral nests.
Conclusion: We proposed a multi-step age-stratified management algorithm integrating clinical, dermoscopic and confocal findings that may increase the early recognition of melanoma and avoid surgical excision of benign nevi. |
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| AbstractList | A peripheral rim of globules represents a marker of the horizontal growth phase in nevi and is a common feature in children and adolescents. The observation of melanocytic lesions with peripheral globules (MLPGs) in adulthood deserves more attention, since melanoma may exhibit this feature, albeit rarely. Risk-stratified management recommendations considering a global clinical approach are still missing.INTRODUCTIONA peripheral rim of globules represents a marker of the horizontal growth phase in nevi and is a common feature in children and adolescents. The observation of melanocytic lesions with peripheral globules (MLPGs) in adulthood deserves more attention, since melanoma may exhibit this feature, albeit rarely. Risk-stratified management recommendations considering a global clinical approach are still missing.To analyze current knowledge on MLPGs and propose an integrated management algorithm stratified for age groups.OBJECTIVESTo analyze current knowledge on MLPGs and propose an integrated management algorithm stratified for age groups.We conducted a narrative review of current published data on MLPGs, analyzing clinical dermoscopic and confocal distinguishing features of melanoma from benign nevi.METHODSWe conducted a narrative review of current published data on MLPGs, analyzing clinical dermoscopic and confocal distinguishing features of melanoma from benign nevi.The risk of finding a melanoma when removing an MLPG increases with age, especially in people >55 years old, and is significantly higher in the extremities, head/neck and in case of a single asymmetrical lesion, ≥6 mm in diameter. Dermoscopic features associated with melanoma diagnosis include atypical peripheral globules, asymmetrical distribution, multiple rims as well as the reappearance of globules after prior loss. In addition, wide blue-grey regression areas, atypical networks, eccentric blotches, tan structureless peripheral areas and vascularization are atypical dermoscopic features. Confocal worrisome findings are represented by pagetoid cells within the epidermis, architectural disarrangement and atypical cells of the dermo-epidermal junction with irregular peripheral nests.RESULTSThe risk of finding a melanoma when removing an MLPG increases with age, especially in people >55 years old, and is significantly higher in the extremities, head/neck and in case of a single asymmetrical lesion, ≥6 mm in diameter. Dermoscopic features associated with melanoma diagnosis include atypical peripheral globules, asymmetrical distribution, multiple rims as well as the reappearance of globules after prior loss. In addition, wide blue-grey regression areas, atypical networks, eccentric blotches, tan structureless peripheral areas and vascularization are atypical dermoscopic features. Confocal worrisome findings are represented by pagetoid cells within the epidermis, architectural disarrangement and atypical cells of the dermo-epidermal junction with irregular peripheral nests.We proposed a multi-step age-stratified management algorithm integrating clinical, dermoscopic and confocal findings that may increase the early recognition of melanoma and avoid surgical excision of benign nevi.CONCLUSIONWe proposed a multi-step age-stratified management algorithm integrating clinical, dermoscopic and confocal findings that may increase the early recognition of melanoma and avoid surgical excision of benign nevi. A peripheral rim of globules represents a marker of the horizontal growth phase in nevi and is a common feature in children and adolescents. The observation of melanocytic lesions with peripheral globules (MLPGs) in adulthood deserves more attention, since melanoma may exhibit this feature, albeit rarely. Risk-stratified management recommendations considering a global clinical approach are still missing. To analyze current knowledge on MLPGs and propose an integrated management algorithm stratified for age groups. We conducted a narrative review of current published data on MLPGs, analyzing clinical dermoscopic and confocal distinguishing features of melanoma from benign nevi. The risk of finding a melanoma when removing an MLPG increases with age, especially in people >55 years old, and is significantly higher in the extremities, head/neck and in case of a single asymmetrical lesion, ≥6 mm in diameter. Dermoscopic features associated with melanoma diagnosis include atypical peripheral globules, asymmetrical distribution, multiple rims as well as the reappearance of globules after prior loss. In addition, wide blue-grey regression areas, atypical networks, eccentric blotches, tan structureless peripheral areas and vascularization are atypical dermoscopic features. Confocal worrisome findings are represented by pagetoid cells within the epidermis, architectural disarrangement and atypical cells of the dermo-epidermal junction with irregular peripheral nests. We proposed a multi-step age-stratified management algorithm integrating clinical, dermoscopic and confocal findings that may increase the early recognition of melanoma and avoid surgical excision of benign nevi. Introduction: A peripheral rim of globules represents a marker of horizontal growth phase in nevi and is a common feature in children and adolescents. The observation of melanocytic lesion with peripheral globules (MLPG) in adulthood deserve more attention, since a melanoma may exhibits this feature albeit rarely. Risk stratified management recommendations considering a global clinical approach are still missing. Objectives: To analyze current knowledge on MLPG and propose an integrated management algorithm stratified for age groups. Methods: We conducted a narrative review of current published data on MPLG, analyzing clinical dermoscopic and confocal distinguishing features of melanoma from bening nevi. Results: The risk of finding a melanoma when removing a MLPG increases with age especially in people >55 years old and results significantly higher on extremities, head/neck and in case of a single asymmetrical lesion, ≥6 mm in diameter. Dermoscopic features associated to melanoma diagnosis include atypical peripheral globules, asymmetrical distribution, multiple rims as well as globules reappearance after previous loss. In addition, wide blue-grey regression areas, atypical network, eccentric blotches, tan structureless peripheral areas and vascularizationare atypical dermoscopic features. Confocal worrisome findingss are represented by pagetoid cells within the epidermis, architectural disarrangement and atypical cells of the dermo-epidermal junction with irregular peripheral nests. Conclusion: We proposed a multi-step age-stratified management algorithm integrating clinical, dermoscopic and confocal findings that may increase the early recognition of melanoma and avoid surgical excision of benign nevi. Introduction: A peripheral rim of globules represents a marker of horizontal growth phase in nevi and is a common feature in children and adolescents. The observation of melanocytic lesion with peripheral globules (MLPG) in adulthood deserve more attention, since a melanoma may exhibits this feature albeit rarely. Risk stratified management recommendations considering a global clinical approach are still missing. Objectives: To analyze current knowledge on MLPG and propose an integrated management algorithm stratified for age groups. Methods: We conducted a narrative review of current published data on MPLG, analyzing clinical dermoscopic and confocal distinguishing features of melanoma from bening nevi. Results: The risk of finding a melanoma when removing a MLPG increases with age especially in people >55 years old and results significantly higher on extremities, head/neck and in case of a single asymmetrical lesion, ≥6 mm in diameter. Dermoscopic features associated to melanoma diagnosis include atypical peripheral globules, asymmetrical distribution, multiple rims as well as globules reappearance after previous loss. In addition, wide blue-grey regression areas, atypical network, eccentric blotches, tan structureless peripheral areas and vascularizationare atypical dermoscopic features. Confocal worrisome findingss are represented by pagetoid cells within the epidermis, architectural disarrangement and atypical cells of the dermo-epidermal junction with irregular peripheral nests. Conclusion: We proposed a multi-step age-stratified management algorithm integrating clinical, dermoscopic and confocal findings that may increase the early recognition of melanoma and avoid surgical excision of benign nevi. |
| Author | Federico, Francesco Ribero, Simone Quattrini, Laura Cappilli, Simone Del Regno, Laura Broganelli, Paolo Di Stefani, Alessandro Cornacchia, Luigi D'Amore, Alessandra Peris, Ketty Catapano, Silvia |
| AuthorAffiliation | 4 Patologia, Dipartimento di Scienze della Vita e Sanità Pubblica, Fondazione Policlinico Universitario A. Gemelli - IRCCS, Rome, Italy 2 Dermatologia, Dipartimento di Medicina e Chirurgia Traslazionale, Università Cattolica del Sacro Cuore, Rome, Italy 1 UOC di Dermatologia, Dipartimento di Scienze Mediche e Chirurgiche, Fondazione Policlinico Universitario A. Gemelli - IRCCS, Rome, Italy 3 Dermatology Clinic, Department of Medical Sciences, University of Turin, Turin, Italy |
| AuthorAffiliation_xml | – name: 2 Dermatologia, Dipartimento di Medicina e Chirurgia Traslazionale, Università Cattolica del Sacro Cuore, Rome, Italy – name: 3 Dermatology Clinic, Department of Medical Sciences, University of Turin, Turin, Italy – name: 4 Patologia, Dipartimento di Scienze della Vita e Sanità Pubblica, Fondazione Policlinico Universitario A. Gemelli - IRCCS, Rome, Italy – name: 1 UOC di Dermatologia, Dipartimento di Scienze Mediche e Chirurgiche, Fondazione Policlinico Universitario A. Gemelli - IRCCS, Rome, Italy |
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| Snippet | Introduction: A peripheral rim of globules represents a marker of horizontal growth phase in nevi and is a common feature in children and adolescents. The... A peripheral rim of globules represents a marker of the horizontal growth phase in nevi and is a common feature in children and adolescents. The observation of... |
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| Title | Melanocytic Lesions With Peripheral Globules: Proposal Of An Integrated Management Algorithm |
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