Melanocytic lesions with peripheral globules in 154 high ris
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The management of melanocytic lesions with peripheral globules (MLPG) is usually age-dependent and can be challenging in high risk melanoma patients. A Study was conducted to evaluate clinical, dermoscopic and RCM features of MLPG in patients under digital dermoscopy surveillance.
During 24 months researchers prospectively enrolled MLPG in digital dermoscopy patients. All were evaluated by dermoscopy, RCM and excised for histological examination.

Results:
Analysis was done on 154 patients, mean age 42,45 years-old (18,78-73,19). 3 melanomas and 19 dysplastic nevus (DN) were diagnosed. There were no significant differences in the age of the patients.
--MLPG with diameter of 6 mm or more and asymmetry in two axis were associated with melanoma. Patients with more than 1 MLPG were less likely to have melanoma. Blue-gray and red color were more frequent in melanoma.
--Different sizes and shapes of PG were associated with DN and melanoma. In a new lesion, PG in less than 25% of the circumference was related to malignancy. RCM signs of malignancy were related to melanoma: pagetoid cells, non-edged papillae, atypical junctional thickenings and atypical cells at the DEJ.
--Dense irregular nests with melanoma. Dermoscopy and confocal evaluation were able to diagnose 100% of melanomas and 21% of DN.
--Kappa coefficient between dermoscopic-RCM vs histology was 0,76.

Researchers recommend to excise a MLPG when it presents asymmetry in two axis, 6 or more mm, new lesion with PG in less than the 25% of the circumference, irregular in size and shape PGs and irregular dense nests on RCM, regardless the patient's age.

Source: https://onlinelibrary.wiley.com/doi/abs/10.1111/jdv.17105?af=R
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