Pigmentation beyond scar’s edge strongly indicated recurrent melanoma

Blum A. JAMA Dermatol. 2013;doi:10.1001/jamadermatol.2013.6908.

  • December 3, 2013

Pigmentation beyond a scar’s edge was significantly more common dermoscopically in recurrent melanoma compared with recurrent nevi, with other differences related to patient age, anatomic site and time to recurrence, according to recent study results.

Researchers conducted a retrospective observational study at 15 pigmented lesion clinics in Argentina, Austria, Belgium, Brazil, France, Germany, Italy, Japan, Mexico, Romania, Spain and the United States. From January through December 2011, 98 recurrent nevi (61.3%) and 62 recurrent melanomas (38.8%) were collected through an email request of all International Dermoscopy Society members. Dermoscopic features, patterns and colors in correlation with histopathologic findings were scored as main outcomes and measures among the cases (patients’ mean age, 43.1 years; 61.3% women).

Radial lines (29.6% vs. 8.1%; P<.001), symmetry (18.4% vs. 6.5%; P=.04) and centrifugal growth pattern (46.9% vs. 12.9%) were more common in recurrent nevi compared with recurrent melanoma, according to univariate analysis. In recurrent melanomas, features that were significantly more common included circles (33.9% vs. 7.1%; P<.001), especially of the head and neck; eccentric hyperpigmentation at the periphery (37.1% vs. 21.4%; P=.045), chaotic (59.7% vs. 22.4%; P<.001) and noncontinous growth patterns (53.2% vs. 29.6%; P=.004) and pigmentation beyond the scar’s edge (87.1% vs. 42.9%; P<.001).

Patients with recurrent melanomas were significantly older (mean age, 63.1 years vs. 30.2 years; P<.001) compared with patients with recurrent nevi and experienced longer time between first and second procedures (median time interval, 25 months vs. 8 months; P<.001). Recurrent melanoma in dermoscopy was independently associated with pigmentation beyond the scar’s edge (P=.002), age (P<.001) and anatomic site (P=.002), according to multivariate analysis.

“Dermoscopically, pigmentation beyond the scar’s edge is the strongest clue for melanoma,” the researchers concluded. “Dermoscopy is helpful in evaluating recurrent lesions, but final interpretation requires taking into account the patient age, anatomic site, time to recurrence, growth pattern and, if available, the histopathologic findings of the first excision.”

Disclosure: The researchers report no relevant financial disclosures.

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