Amelanotic/hypomelanotic melanoma: clinical and dermoscopic features

Background Amelanotic malignant melanoma is a subtype of cutaneous melanoma with little or no pigment on visual inspection. It may mimic benign and malignant variants of both melanocytic and nonmelanocytic lesions. Objectives To evaluate whether dermoscopy is also a useful technique for the diagnosis of amelanotic/hypomelanotic melanoma (AHM). Methods We conducted a retrospective clinical study of 151 amelanotic/hypomelanotic skin lesions from 151 patients with a mean age of 47 years ( +/- 17.5 SD). Digitized images of amelanotic/hypomelanotic skin lesions were converted to JPEG format and sent by e-mail from the five participating centres. Lesions included 55 amelanotic/hypornelanotic nonmelanocytic lesions (AHNML), 52 amelanotic/hypomelanotic benign melanocytic lesions (AFMML), and 44 AHM, 10 (23%) of which were nonpigmented, truly amelanotic melanomas (AM). The 44 AHM lesions were divided into thin melanomas (TnM) less than or equal to 1 mm (2 9 cases) and thick melanomas (TkM) > 1 mm (15 cases), according to the Breslow index. Five clinical features (elevation, ulceration, shape, borders and colour) as well as 10 dermoscopic criteria (pigment network, pigmentation, streaks, dots/globules, blue-whitish veil, regression structures, hypopigmentation, leaf-like areas, multiple grey-bluish globules, central white patch) and eight vascular patterns (comma, arborizing, hairpin, dotted, linear irregular, dotted and linear irregular vessels, and milky-red areas) were evaluated in order to achieve clinical and dermoscopic diagnoses. Statistical analyses were performed with the chi(2)-test and Fisher's exact test, when appropriate. Results The most frequent and significant clinical features for TnM and TkM were asymmetry and ulceration (the latter only for TkM) compared with AHBML. Irregular dots/globules (62% vs. 35%; P less than or equal to 0.03), regression structures (48% vs. 27%; P less than or equal to 0.03), irregular pigmentation (41% vs. 11%; P less than or equal to 0.03) and blue-whitish veil (10% vs. 0%; P less than or equal to 0.03) were the most relevant dermoscopic criteria for TnM in comparison with AHBML. TkM differed significantly from AHBML in frequency of occurrence of irregular pigmentation (87% vs. 11%; P less than or equal to 0.03), irregular dots/globules (73% vs. 35%; P less than or equal to 0.03), regression structures (67% vs. 27%; P less than or equal to 0.03), blue-whitish veil (27% vs. 0%; P less than or equal to 0.03) and hypopigmentation (13% vs. 55%; P less than or equal to 0.03). Linear irregular vessels and the were diagnosed as either benign melanocytic lesion (four cases) or BCC (two cases).