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The Best of the Best
August 16, 2010

Top-Accessed Article: Dermoscopy of Amelanotic and Hypomelanotic Melanoma

Arch Dermatol. 2010;146(8):885. doi:10.1001/archdermatol.2010.160

Menzies SW, Kreusch J, Byth K, et al. Dermoscopic evaluation of amelanotic and hypomelanotic melanoma. Arch Dermatol. 2008;144(9):1120-1127.

Amelanotic and hypomelanotic melanomas of the skin pose a considerable diagnostic challenge. In this retrospective, multicentered study, Menzies and colleagues identified key dermoscopic features for distinguishing 105 amelanotic and hypomelanotic melanomas from 222 nonmelanocytic and 170 benign melanocytic lesions that lacked significant pigmentation. The most notable positive predictors include a blue-white veil, scarlike depigmentation, multiple blue-gray dots, irregularly shaped depigmentation, and irregular brown dots or globules. The morphological features, which include predominant central vessels, milky red-pink areas, more than 1 shade of pink, and a combination of dotted and linear irregular vessels, are also important for diagnosis. It is noteworthy that the images were captured with glass-plate dermoscopy devices, with compression of the underlying vessels varying according to the amount of pressure applied. It is very likely that more significant vessel details may be found using cross-polarized noncontact dermoscopes.

In summary, the dermoscopic features in this study provide valuable clues for diagnosing amelanotic and hypomelanotic melanomas. Future studies with polarized devices may offer additional diagnostic features.

From June 2004 through August 2009, this article was viewed 3239 times on the Archives of Dermatology Web site.

Contact Dr Wang at the Division of Dermatology, Memorial Sloan-Kettering Cancer Center, 160 E 53rd St, New York, NY 10022 (sqwang01@yahoo.com).