Medical Faculty University of Zenica, Bosnia and Herzegovina
Title: Small-diameter melanomas: clinical-dermoscopic challenge in early diagnosis
Biography: Irdina Drljevic
Background: Melanoma is a leading cause of death from skin diseases due to potentially lethal nature. Thus, early diagnosis of melanoma cannot be overemphasized because thin melanomas have an excellent prognosis. Special difficulties in early detection of melanoma lie in melanocytic lesions whose diameter is below 6 mm, hypo-pigmented and non-pigmented lesions, and regular and rather clearly defined papular and nodular lesions regardless of their color (differential diagnosis: desmoplastic melanoma, Spitz nevus, Blue nevus). Briefly, there are many reasons to miss the diagnosis of small-diameter melanoma, particularly because melanoma is an excellent imitator of benign skin tumors. On the other hand, we can always use clinical, well-known ABCDE acronym for small-diameter melanomas and the dermoscopy as an additional diagnostic test often prevents the application and questions the “excellence” of known dermoscopic algorithms.
Aim: Emphasize and pay attention to this diagnostic challenge in everyday clinical and dermoscopic practice.
Method: We have demonstrated several interesting clinical-dermoscopic cases of patho-histologically verified melanoma with the diameter below 6 mm, including a rare naevoid malignant melanoma. We analyzed gender, age, anatomic localization, dermoscopic structures and patho-histological parameters, especially in terms of prognostic factors.
Conclusions: In order to recognize very small melanoma total body skin examination (TBSE) needs to be performed, detailed family and personal anamnesis needs to be obtained, the clinical ABCDE acronym is to be followed as much as possible and the classical algorithm, so called pattern analysis, should be applied in dermoscopic analysis of a suspicious lesion. Timely diagnosis and excision of the suspicious lesion with pathohistological verification are crucial for the prognosis, i.e. patient’s survival.
1 Drljevic I. Face melanoma and dermoscopy including differential diagnosis. IV Congress of Dermatovenerologists of Mecedonia with international participation. Ohrid, Macedonia,2009.
2 Drljevic I. Risk of a second cutaneous primary melanoma and basal cell carcinoma in patients with a previous primary diagnosisof melanoma: true impact of dermoscopy follow-up in the identification of high-risk persons. Serbian Jornal od Dermatology and Venereology. 2010; 2 (4): 146-148.
3 Drljevic I. Dermoscopy of head melanoma-case studies and review of references. Our Dermatology Online Journal. 2012; 3(2): 123-125.
4 Bandic J, Dobrosavljevic D, Drljevic I. et sur. Double coparison of teledermoscopy: Interobserver variability and relation to histpathology. Abstracts from the 3rd World Congress of Dermoscopy, May 17 to 19, 2012, Brisbane, Australia. Dermatol Pract Conc. 2012; 2 (2 suppl):16
5 Drljevic I. Melanoma malignum and basal cell carcinoma. Skin cancer of the skin-case reports of skin tumors. Our Dermatology Online Journal. 2014; 35-36.
6 Drljevic I. Superficial spreading and nodular melanoma. Skin cancer of the skin-case reports of skin tumors. Our Dermatology Online Journal. 2014; 50-52.
7 Drljevic I. Supeficial spreading melanoma and basal cell carcinoma. Skin cancer of the skin-case reports of skin tumors. Our Dermatology Online Journal. 2014.
8 Drljevic I, Bjeloševic E, Denjalic A, Drljevic K. Melanocytic lesions and dermoscopy in childhood: diagnosis, therapy and foloving. Our Dermatol Online. 2016; 7(1): 97-100.