Extensive regression in pigmented skin lesions: a dangerous confounding feature
Keywords:
pigmented lesion, regression, melanoma, lichen plants-like keratosisAbstract
Spontaneous regression in melanomas is not an uncommon phenomenon, as it has been described in 10-35% of primary cutaneous lesions [1]. Regression does not appear to predict a more favorable course, since even fully regressed melanomas may progress into metastatic disease [2]. Several dermoscopic features have been correlated with the regression process, including white scar-like depigmented areas and gray-blue, pepper-like granules, which correspond to dermal scarring, pigment incontinence and presence of melanophages [3,4]. Regression may occur not only in melanomas, but also in melanocytic nevi, which similarly may exhibit white areas and gray-blue granules or areas under dermoscopy [5]. Overall, white areas have been proposed to be associated with the fibrosis type of regression and gray-blue areas to the melanosis type of regression of melanocytic tumors [3]. Lichen planus like keratosis (LPLK) is considered to represent a regressed solar lentigo or seborrheic keratosis. Dermoscopy of LPLK at the late stage of the regression process reveals a diffuse gray-blue granular pattern, similar to that observed in regressed melanocytic lesions [6].
In this context, when evaluating skin lesions that exhibit high degree of regression, interpretation of dermoscopic findings may be problematic, especially when no other dermoscopic clues can be recognized.
References
2. B ories N, D alle S, D ebarbieux S, Balme B, Ronger-Savié S, Thomas L. Dermoscopy of fully regressed cutaneous melanoma. Br J Dermatol. 2008;158(6):1224-9.
3. Zalaudek I, Argenziano G, Ferrara G, et al. Clinically equivocal melanocytic skin lesions with features of regression: a dermoscopic-pathological study. Br J Dermatol. 2004;150(1):64-71.
4. Massi D, De Giorgi V, Carli P, Santucci M. Diagnostic significance of the blue hue in dermoscopy of melanocytic lesions: a dermoscopic-pathologic study. Am J Dermatopathol. 2001;23(5):463-9.
5. Menzies SW, Gutenev A, Avramidis M, Baltrac A, McCarthy WH. Short-term digital surface microscopic monitoring of atypical or changing melanocytic lesions. Arch Dermatol. 2001;137(12):1583-9.
6. Raptoulis G, Spencer R, Einstein B, Oliviero M, Braun R, Rabinovitz H. Lichen planus-like keratosis of the face: a simulator of melanoma in situ. Dermatol Surg. 2007;33(7):854-6.
7. Oliviero M, Rabinovitz H. Lichen planus-like keratosis. In: Malvehy J, Puig S (eds). Principles of Dermoscopy. Barcelona, Spain: Self-Published, 2002:145-54.
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