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Optical coherence tomography (OCT) features of nevi and melanomas and their association with intraepidermal or dermal involvement: A pilot study

2015; Elsevier BV; Volume: 73; Issue: 2 Linguagem: Inglês

10.1016/j.jaad.2015.05.009

1097-6787

Tatiana Blumetti, Marcela Pécora Cohen, Elimar Elias Gomes, Mariana Petaccia de Macêdo, Maria Dirlei Ferreira de Souza Begnami, José Humberto Tavares Guerreiro Fregnani, João Pedreira Duprat Neto, Giovanni Pellacani, Gisele Gargantini Rezze,

Cell Adhesion Molecules Research

To the Editor: Optical coherence tomography (OCT) was shown to be an useful tool for the fast evaluation of nonmelanocytic tumors of the skin.1Welzel J. Optical coherence tomography in dermatology: a review.Skin Res Technol. 2001; 7: 1-9Crossref PubMed Scopus (514) Google Scholar There are few reports in the literature studying melanocytic lesions with OCT, with variable and sometimes contrasting results.2Gambichler T. Jaedicke V. Terras S. Optical coherence tomography in dermatology: technical and clinical aspects.Arch Dermatol Res. 2011; 303: 457-473Crossref PubMed Scopus (186) Google Scholar, 3Boone M.A. Norrenberg S. Jemec G.B. Del Marmol V. High-definition optical coherence tomography imaging of melanocytic lesions: a pilot study.Arch Dermatol Res. 2013; 306: 11-26Crossref PubMed Scopus (61) Google Scholar A constant need for reducing costs and cosmetic concerns of unnecessary excisions of suspicious melanocytic lesions lead us to further investigate this new technology.4Pellacani G. Pepe P. Casari A. Longo C. Reflectance confocal microscopy as a second-level examination in skin oncology improves diagnostic accuracy and saves unnecessary excisions: a longitudinal prospective study.Br J Dermatol. 2014; 171: 1044-1051Crossref PubMed Scopus (143) Google ScholarWe used OCT (Vivosight OCT Scanner, Michelson Diagnostics Ltd, Orpington, Kent, United Kingdom) to evaluate a total of 39 lesions: 19 melanomas (10 in situ and 9 invasive, with Breslow thickness <1 mm), 15 compound nevi, and 5 junctional nevi. No lesions from palms, soles, and mucosal areas were included because of the peculiarity of skin anatomy in these areas. Our first goal was to design a pattern of findings in melanocytic lesions on OCT. Secondly, we aimed to explore the correlation between histopathology and OCT features through the evaluation of skin compartments, and to assess its significance in the diagnosis of melanoma.One image sequence (60 per lesion) belonging to each case was selected for assessment. Two evaluators, an experienced dermatologist in imaging in dermatology (T. C. M. P. B.) and a radiologist (M. P. C.), independently analyzed the lesions regarding the OCT features. Eleven features present in the epidermis, dermoepidermal junction, and dermis were separately evaluated, including criteria previously identified in the literature for melanocytic lesions, and newly described features (Fig 1, Fig 2).3Boone M.A. Norrenberg S. Jemec G.B. Del Marmol V. High-definition optical coherence tomography imaging of melanocytic lesions: a pilot study.Arch Dermatol Res. 2013; 306: 11-26Crossref PubMed Scopus (61) Google Scholar, 5Gambichler T. Regeniter P. Bechara F.G. et al.Characterization of benign and malignant melanocytic skin lesions using optical coherence tomography in vivo.J Am Acad Dermatol. 2007; 57: 629-637Abstract Full Text Full Text PDF PubMed Scopus (122) Google Scholar Findings were finally analyzed by both evaluators for all lesions and binarized as present or absent in agreement.Fig 2Optical coherence tomography images and corresponding schematic images of the previously reported and new structures observed in the dermoepidermal junction (DEJ) and dermis. A, DEJ, melanoma in situ: loss of normal dermoepidermal index (inversion of normal reflective properties of the skin with epidermis hyporeflective/dermis hyperreflective). B, Junctional nevus: clear visualization of junctional nests (hyporeflective rounded areas well demarcated localized in the apical areas of rete ridges). C, Dermis, compound nevus: hyporeflective band (hyporeflective homogeneous band in dermis parallel to epidermis close to DEJ, preserving the hyperreflective collagen underneath). D, Invasive melanoma: icicle-shaped structures (hyperreflective large vertical icicle-shaped structures reaching the reticular dermis with their peak aspect). E and F, Melanoma in situ and invasive melanoma: shadows (focal areas with complete loss of visualization of dermis). Collagen (dermis with its normal hyperreflectivity bundles between linear hyporeflective structures) can be observed clearly (B and C). B and D are already described features in literature.3Boone M.A. Norrenberg S. Jemec G.B. Del Marmol V. High-definition optical coherence tomography imaging of melanocytic lesions: a pilot study.Arch Dermatol Res. 2013; 306: 11-26Crossref PubMed Scopus (61) Google Scholar, 5Gambichler T. Regeniter P. Bechara F.G. et al.Characterization of benign and malignant melanocytic skin lesions using optical coherence tomography in vivo.J Am Acad Dermatol. 2007; 57: 629-637Abstract Full Text Full Text PDF PubMed Scopus (122) Google ScholarView Large Image Figure ViewerDownload Hi-res image Download (PPT)The histopathology study first categorized melanocytic lesions as melanoma in situ, invasive melanoma, junctional nevus, or compound nevus. Anatomical compartment of tumor proliferation was reported as intraepidermal (for in situ melanoma and junctional nevi), and within the dermis (for invasive melanomas and compound nevi). Statistical analysis was carried out using software (SPSS, Release 20.0.0, IBM Corp, Armonk, NY). Absolute and relative frequencies were calculated. Fisher's exact test was used to evaluate the differences in OCT features between nevi and melanoma. The significance level was set at 5% (P < .05) (Table I).Table IOptical coherence tomography features in the different compartments of the skin and their distribution in melanomas and neviOCT featureMelanomas (n = 19)Nevi (n = 20)P value∗For Fisher's exact test.In situ melanomas10 (100%)Invasive melanomas9 (100%)Junctional nevi5 (100%)Compound nevi15 (100%)Melanoma vs compound neviInvasive melanoma vs compound neviJunctional vs compound neviEpidermis Rete ridges6 (60)2 (22)5 (100)3 (20).2711.002†Statistical significance. Elongation7 (70)4 (44)3 (60)3 (20).038†Statistical significance..356.045†Statistical significance. Fusion5 (50)4 (44)3 (60)4 (27).296.412.318 Enlargement7 (70)4 (44)3 (60)5 (33).185.678.105 Rectification1 (10)2 (22)0 (0)0 (0).238.1301Dermoepidermal junction Loss of normal dermoepidermal index4 (40)6 (67)0 (0)7 (47)1.423.112 Junctional nests7 (70)6 (67)5 (100)12 (80).697.6351Dermis Shadows8 (80)8 (89)0 (0)3 (20)<.001†Statistical significance..002†Statistical significance..748 Collagen5 (50)1 (11)5 (100)13 (87).002†Statistical significance.<.001†Statistical significance..740 Hyporeflective band3 (30)3 (33)0 (0)12 (80).007†Statistical significance..036†Statistical significance..019†Statistical significance. Icicle-shaped structures0 (0)3 (33)0 (0)2 (13)1.326.136OCT, Optical coherence tomography.∗ For Fisher's exact test.† Statistical significance. Open table in a new tab The presence of shadows correlated significantly with in situ melanoma (8 in 10 cases, P = .007). Shadows and loss of bright collagen correlated with invasive melanoma, compared with compound nevi (P = .002 and P <.001). Hyporeflective band was associated with compound nevi (80%), and less frequently found in melanomas (31.5%, P = .007).Concerning the distinction between melanomas and nevi, the presence of dermal shadows and absence of bright collagen were the most relevant parameters to suggest malignancy. The lack of hyporeflective bands on invasive melanomas represented a distinguishing feature from compound nevi.To understand the value of OCT in the diagnosis of melanoma a larger population should be tested. We can hypothesize that OCT may help to define the tumor burden and eventual dermal infiltration of melanocytic tumors, which could influence the choice of surgical procedure between shaving or complete excision of clinically suspicious lesions. The study was approved by the institutional review board (Committee of Ethics in Research, AC Camargo Cancer Center) in September 2013 (registration number: 1767/13B). To the Editor: Optical coherence tomography (OCT) was shown to be an useful tool for the fast evaluation of nonmelanocytic tumors of the skin.1Welzel J. Optical coherence tomography in dermatology: a review.Skin Res Technol. 2001; 7: 1-9Crossref PubMed Scopus (514) Google Scholar There are few reports in the literature studying melanocytic lesions with OCT, with variable and sometimes contrasting results.2Gambichler T. Jaedicke V. Terras S. Optical coherence tomography in dermatology: technical and clinical aspects.Arch Dermatol Res. 2011; 303: 457-473Crossref PubMed Scopus (186) Google Scholar, 3Boone M.A. Norrenberg S. Jemec G.B. Del Marmol V. High-definition optical coherence tomography imaging of melanocytic lesions: a pilot study.Arch Dermatol Res. 2013; 306: 11-26Crossref PubMed Scopus (61) Google Scholar A constant need for reducing costs and cosmetic concerns of unnecessary excisions of suspicious melanocytic lesions lead us to further investigate this new technology.4Pellacani G. Pepe P. Casari A. Longo C. Reflectance confocal microscopy as a second-level examination in skin oncology improves diagnostic accuracy and saves unnecessary excisions: a longitudinal prospective study.Br J Dermatol. 2014; 171: 1044-1051Crossref PubMed Scopus (143) Google Scholar We used OCT (Vivosight OCT Scanner, Michelson Diagnostics Ltd, Orpington, Kent, United Kingdom) to evaluate a total of 39 lesions: 19 melanomas (10 in situ and 9 invasive, with Breslow thickness <1 mm), 15 compound nevi, and 5 junctional nevi. No lesions from palms, soles, and mucosal areas were included because of the peculiarity of skin anatomy in these areas. Our first goal was to design a pattern of findings in melanocytic lesions on OCT. Secondly, we aimed to explore the correlation between histopathology and OCT features through the evaluation of skin compartments, and to assess its significance in the diagnosis of melanoma. One image sequence (60 per lesion) belonging to each case was selected for assessment. Two evaluators, an experienced dermatologist in imaging in dermatology (T. C. M. P. B.) and a radiologist (M. P. C.), independently analyzed the lesions regarding the OCT features. Eleven features present in the epidermis, dermoepidermal junction, and dermis were separately evaluated, including criteria previously identified in the literature for melanocytic lesions, and newly described features (Fig 1, Fig 2).3Boone M.A. Norrenberg S. Jemec G.B. Del Marmol V. High-definition optical coherence tomography imaging of melanocytic lesions: a pilot study.Arch Dermatol Res. 2013; 306: 11-26Crossref PubMed Scopus (61) Google Scholar, 5Gambichler T. Regeniter P. Bechara F.G. et al.Characterization of benign and malignant melanocytic skin lesions using optical coherence tomography in vivo.J Am Acad Dermatol. 2007; 57: 629-637Abstract Full Text Full Text PDF PubMed Scopus (122) Google Scholar Findings were finally analyzed by both evaluators for all lesions and binarized as present or absent in agreement. The histopathology study first categorized melanocytic lesions as melanoma in situ, invasive melanoma, junctional nevus, or compound nevus. Anatomical compartment of tumor proliferation was reported as intraepidermal (for in situ melanoma and junctional nevi), and within the dermis (for invasive melanomas and compound nevi). Statistical analysis was carried out using software (SPSS, Release 20.0.0, IBM Corp, Armonk, NY). Absolute and relative frequencies were calculated. Fisher's exact test was used to evaluate the differences in OCT features between nevi and melanoma. The significance level was set at 5% (P < .05) (Table I). OCT, Optical coherence tomography. The presence of shadows correlated significantly with in situ melanoma (8 in 10 cases, P = .007). Shadows and loss of bright collagen correlated with invasive melanoma, compared with compound nevi (P = .002 and P <.001). Hyporeflective band was associated with compound nevi (80%), and less frequently found in melanomas (31.5%, P = .007). Concerning the distinction between melanomas and nevi, the presence of dermal shadows and absence of bright collagen were the most relevant parameters to suggest malignancy. The lack of hyporeflective bands on invasive melanomas represented a distinguishing feature from compound nevi. To understand the value of OCT in the diagnosis of melanoma a larger population should be tested. We can hypothesize that OCT may help to define the tumor burden and eventual dermal infiltration of melanocytic tumors, which could influence the choice of surgical procedure between shaving or complete excision of clinically suspicious lesions. The study was approved by the institutional review board (Committee of Ethics in Research, AC Camargo Cancer Center) in September 2013 (registration number: 1767/13B).