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December 15, 2008

Remodeling of the Dermoepidermal Junction in Superficial Spreading Melanoma: Insights Gained From Correlation of Dermoscopy, Reflectance Confocal Microscopy, and Histopathologic Analysis

Arch Dermatol. 2008;144(12):1644-1649. doi:10.1001/archdermatol.2008.504

Diagnosis in dermatology, whether rendered clinically or histopathologically, relies on the analytical examination of the primary morphologic features of the lesion on the gross or microscopic level, respectively. During the past 2 decades, we have begun to appreciate a new dimension in primary morphologic analysis, namely, the in vivo, en face macroscopic and microscopic morphologic features as seen via dermoscopy and reflectance confocal microscopy (RCM). Like dermoscopy, RCM reveals morphologic details of architecture in the en face plane, but, in addition, it provides morphologic information on the cellular level.1 The ability to visualize a lesion's primary morphologic features on multiple different levels has fueled new insights into the biological evolution of lesions. This month's Archives of Dermatology features an important article by Pellacani et al2 that correlates dermoscopic structures of melanocytic lesions with RCM and histopathologic analysis. This editorial, which is based on the findings reported by Pellacani et al2 and other correlation studies on dermoscopy, RCM, and histopathology,1,3-5 offers new theoretical insights into the biological progression of superficial spreading malignant melanoma (MM) by describing the concept of dermoepidermal junction (DEJ) remodeling. Although the remodeling concept remains speculative, we hope that it will spawn new research focused on elucidating the mechanisms involved in the growth and evolution of early MM.

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