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. 2018 Sep;32(9):1450-1455.
doi: 10.1111/jdv.14712. Epub 2017 Dec 18.

Educational and practice gaps in the management of volar melanocytic lesions

C M Costello  1   2 , S Ghanavatian  1 , M Temkit  3 , M R Buras  3 , D J DiCaudo  1 , D L Swanson  1 , A R Mangold  1
Affiliations

Educational and practice gaps in the management of volar melanocytic lesions

C M Costello et al. J Eur Acad Dermatol Venereol. 2018 Sep.

Abstract

Background: The benign and malignant patterns of acral melanocytic naevi (AMN) and acral melanomas (AM) have been defined in a series of retrospective studies. A three-step algorithm was developed to determine when to biopsy acral melanocytic lesions. This algorithm has only been applied to a Japanese population.

Objectives: Our study aimed to review the current management strategy of acral melanocytic lesions and to investigate the utility of the three-step algorithm in a predominately Caucasian cohort.

Methods: A retrospective search of the pathology and image databases at Mayo Clinic was performed between the years 2006 and 2016. Only cases located on a volar surface with dermoscopic images were included. Two dermatologists reviewed all dermoscopic images and assigned a global dermoscopic pattern. Clinical and follow-up data were gathered by chart review. All lesions with known diameter and pathological diagnosis were used for the three-step algorithm.

Results: Regular fibrillar and ridge patterns were more likely to be biopsied (P = 0.01). The majority of AMN (58.1%) and AM (60%) biopsied were due to physician-deemed concerning dermoscopic patterns. 39.2% of these cases were parallel furrow, lattice-like or regular fibrillar. When patients were asked to follow-up within a 3- to 6-month period, only 16.7% of the patients returned within that interval. The three-step algorithm would have correctly identified four of five AM for biopsy, missing a 6 mm, multicomponent, invasive melanoma.

Conclusion: We found one major educational gap in the recognition of low-risk lesions with high rates of biopsy of the fibrillary pattern. Recognizing low-risk dermoscopic patterns could reduce the rate of biopsy of AMN by 23.3%. We identified two major practice gaps, poor patient compliance with follow-up and the potential insensitivity of the three-step algorithm to small multicomponent acral melanocytic lesions.

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Conflict of interest statement

None of the authors have any conflicts of interest to disclose.

Figures

Figure 1
Figure 1
Dermoscopic patterns – Parallel furrow, Lattice-like, and Regular Fibrillar are low risk patterns, Parallel Ridge and Multi-component are high-risk patterns.
Figure 2
Figure 2
3-Step Algorithm –*6mm, multicomponent acral melanoma; Parallel furrow pattern (PFP), lattice-like pattern (LLP), acral melanoma (AM)
Figure 3
Figure 3
Potentially missed acral melanoma by 3-step algorithm- A 6mm, 0.5mm Breslow thickness, multi-component pattern. a) clinical photograph b) contact dermoscopy
See this image and copyright information in PMC

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