The Importance of In Vivo Reflectance Confocal Microscopy in a Case of Desmoplastic Melanoma.

Autor: Cristescu MI; Elias University Emergency Hospital, 011461 Bucharest, Romania., Popa LG; Elias University Emergency Hospital, 011461 Bucharest, Romania.; Department of Dermatology, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania., Cozma EC; Elias University Emergency Hospital, 011461 Bucharest, Romania.; Department of Pathophysiology, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania., Celarel AM; Elias University Emergency Hospital, 011461 Bucharest, Romania., Popa VT; Department of Dermatology, Victor Babes University of Medicine and Pharmacy, 300041 Timisoara, Romania., Lupu M; Department of Dermatology, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania., Voiculescu VM; Elias University Emergency Hospital, 011461 Bucharest, Romania.; Department of Dermatology, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania.
Jazyk: angličtina
Zdroj: Life (Basel, Switzerland) [Life (Basel)] 2024 Apr 30; Vol. 14 (5). Date of Electronic Publication: 2024 Apr 30.
DOI: 10.3390/life14050574
Abstrakt: Desmoplastic melanoma accounts for 5% of all cases of melanoma, but its diagnosis can be difficult due to its frequent clinical presentation with amelanotic lesions. Histologically, spindled melanocytes surrounded by a collagenous stroma are observed. Compared with other types of melanoma, the desmoplastic types presents greater local aggression, and is more prone to local recurrence, but has a lower risk of lymph node metastasis. Early detection, accurate staging, and proper surgical management are the main factors associated with higher survival rates in melanoma patients. Reflectance confocal microscopy (RCM) has proven to be a valuable imaging tool in the diagnosis of skin neoplasms, being useful for orientating practitioners towards the diagnosis of melanoma and indicating the necessity of performing a diagnostic biopsy. We present the case of 52-year-old woman, who presented to the dermatology department with an irregular, dark-colored plaque in the right deltoid region. Dermoscopy showed asymmetry with an atypical network and some areas of regression. RCM revealed pagetoid cells in the upper epidermis, cell atypia, non-edged papillae, dermal inflammation, and nucleated cells in the dermis, which are highly suggestive of melanoma. A biopsy was also performed. A histopathology exam confirmed the diagnosis of superficially spreading melanoma with a desmoplastic component, and revealed a Breslow index of 0.9 mm, Clark level IV, an absence of mitoses, angiolymphatic invasion and regression, and complete excision. The CT and PET-CT scans were negative. A biopsy of the axillary sentinel lymph node was conducted, with a negative result obtained, establishing the IB stage of the disease. The patient will remain under follow-up to look for a recurrence or a new primary melanoma.
Databáze: MEDLINE
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