Recurrent Melanocytic Nevi and Melanomas in Dermoscopy: Results of a Multicenter Study of the International Dermoscopy Society | Dermatology | JAMA Dermatology | JAMA Network
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Original Investigation
February 2014

Recurrent Melanocytic Nevi and Melanomas in Dermoscopy: Results of a Multicenter Study of the International Dermoscopy Society

Author Affiliations
  • 1Public, Private, and Teaching Practice of Dermatology, Konstanz, Germany
  • 2Medical University of Graz, Graz, Austria
  • 3Dermatology Service, Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, New York
  • 4Skin Cancer Unit, Arcispedale Santa Maria Nuova IRCCS, Reggio Emilia, Italy
  • 5Medical Research Institute “A. Lanari,” University of Buenos Aires, Buenos Aires, Argentina
  • 6Melanoma Unit, Department of Dermatology, Hospital Clinic Barcelona, Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Centro de Investigacion Biomedica en red de enfermedades raras (CIBERER) Enfermedades rara, Barcelona, Spain
  • 7Skin Cancer and Dermatology Center, Hospital AC Camargo São Paulo, Brazil
  • 8Public and Private Practice of Dermatology, Lille, France
  • 9Departamento de Introducción a la Clínica, Facultad de Medicina, UANL, Monterrey, México
  • 10Department of Dermatology, University of Brescia, Brescia, Italy
  • 11First Dermatological Clinic, Carol Davila University of Medicine and Pharmacy, Colentina Hospital, Bucharest, Romania
  • 12Department of Dermatology, Tokyo Women’s Medical University Medical Center East, Tokyo, Japan
  • 13Department of Dermatology, Lyon 1 University Centre Hospitalier Lyon Sud, Pierre Bénite, France
  • 14Department of Dermatology, Centre du Cancer, Cliniques Universitaires St Luc, Université Catholique de Louvain, Brussels, Belgium
  • 15Department of Dermatology, Medical University of Vienna, Vienna, Austria
JAMA Dermatol. 2014;150(2):138-145. doi:10.1001/jamadermatol.2013.6908

Importance  Differentiating recurrent nevi from recurrent melanoma is challenging.

Objective  To determine dermoscopic features to differentiate recurrent nevi from melanomas.

Design, Setting, and Participants  Retrospective observational study of 15 pigmented lesion clinics from 12 countries; 98 recurrent nevi (61.3%) and 62 recurrent melanomas (38.8%) were collected from January to December 2011.

Main Outcomes and Measures  Scoring the dermoscopic features, patterns, and colors in correlation with the histopathologic findings.

Results  In univariate analysis, radial lines, symmetry, and centrifugal growth pattern were significantly more common dermoscopically in recurrent nevi; in contrast, circles, especially if on the head and neck area, eccentric hyperpigmentation at the periphery, a chaotic and noncontinuous growth pattern, and pigmentation beyond the scar's edge were significantly more common in recurrent melanomas. Patients with recurrent melanomas were significantly older than patients with recurrent nevi (mean [SD] age, 63.1 [17.5] years vs 30.2 [12.4] years) (P < .001), and there was a significantly longer time interval between the first procedure and the second treatment (median time interval, 25 vs 8 months) (P < .001). In a multivariate analysis, pigmentation beyond the scar’s edge (P = .002), age (P < .001), and anatomic site (P = .002) were significantly and independently associated with the diagnosis of recurrent melanoma in dermoscopy.

Conclusions and Relevance  Dermoscopically, pigmentation beyond the scar’s edge is the strongest clue for melanoma. 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.