Drugge, Elizabeth D

Drugge, Rhett J.

Elston, Dirk M.

Sarac, Rebecca M.

Strang, Sophie R.

Volpicelli, Elgida R.

English

The Touro College and University System

Touro Scholar NYMC Faculty Publications Faculty 1-1-2018 Micromelanomas Identified with Time-Lapse Total Body Photography and Dermoscopy Elizabeth D. Drugge New York Medical College Elgida R. Volpicelli Rebecca M. Sarac Sophie R. Strang Dirk M. Elston See next page for additional authors Follow this and additional works at: https://touroscholar.touro.edu/nymc_fac_pubs  Part of the Neoplasms Commons, and the Skin and Connective Tissue Diseases Commons Recommended Citation Drugge, E. D., Volpicelli, E., Sarac, R., Strang, S., Elston, D., & Drugge, R. (2018). Micromelanomas Identified with Time-Lapse Total Body Photography and Dermoscopy. Journal of the American Academy of Dermatology, 78 (1), 182-183. https://doi.org/10.1016/j.jaad.2017.07.049 This Letter to the Editor is brought to you for free and open access by the Faculty at Touro Scholar. It has been accepted for inclusion in NYMC Faculty Publications by an authorized administrator of Touro Scholar. For more information, please contact daloia@nymc.edu. Authors Elizabeth D. Drugge, Elgida R. Volpicelli, Rebecca M. Sarac, Sophie R. Strang, Dirk M. Elston, and Rhett J. Drugge This letter to the editor is available at Touro Scholar: https://touroscholar.touro.edu/nymc_fac_pubs/1081   1  Ref. MS.NO.JAAD-D-16-01647 1 Micromelanomas Identified with Time-Lapse Total Body Photography and 2 Dermatoscopy 3  4 Elizabeth D. Drugge, PhD, MPH1, Elgida R. Volpicelli, MD2, Rebecca M.Sarac, BS3, Sophie 5 R. Strang, MBChB4, Dirk M. Elston, MD5 and Rhett J. Drugge, MD6  6 Author Affiliations: 7 1New York Medical College, Valhalla, NY; 8 2Stamford Hospital, Stamford, CT;  9 3Tulane University School of Medicine, New Orleans, LA;  10 4University of Birmingham, UK;  11 5Medical University of South Carolina, Charlestown, SC;  12 6Sheard & Drugge, PC, Stamford, CT 13 Acknowledgements:  14 George F. Murphy, MD, Director of Dermatopathology, BWH-Consultant 15 IRB: I RB Assu rance 00002052 (see attached) 16 Corresponding author:  17 Elizabeth D. Drugge, PhD, MPH 18 Elizabeth.Drugge@gmail.com 19 New York Medical College School of Health Sciences and Practice 20 Department of Epidemiology & Community Health 21 Valhalla, NY 10595 22   2  Fax: (203)323-7485 23 Phone:(203)246-4562  24 Author Contributions: Drs. Elizabeth Drugge and Elgida Volpicelli had full access to all 25 of the data in the study and take responsibility for the integrity of the data and 26 accuracy of the reporting.  27 Funding/Support: This article has no funding source. 28 Conflict of Interest Disclosure of the Authors: Dr. Rhett Drugge is the inventor and 29 holder of the intellectual property rights (US 7,359,748) of the Melanoscan system.  30 Dr. Elizabeth Drugge is a first-degree relative of Dr. Rhett Drugge.   31 Prior Presentation: None 32 Word count: (text) 499; (references) 158; (figure legends) 122 33 Number of references: 5 34 Number of figures: 2 35 Reprints: Requested   36 37   3  Abbreviations:  Melanoma (MM), Micromelanoma (MicroMM), Melanoma-in-Situ (MIS), 38 Invasive (INV), American Academy of Dermatology (AAD), Asymmetry, Border 39 Irregularity, Colors (two or more), Diameter (>6 mm), Evolution (ABCDE), Brigham and 40 Women’s Hospital (BWH)   41  42   4  To the Editor: 1      Secondary prevention efforts to detect malignant melanoma (MM) focus on 2 lesions at an initial growth phase with diameters less than 6 mm; earlier detection 3 correlates with improved survival rates.1Two photographic approaches provide 4 critical and complementary information in the differential diagnosis of MM.  Total 5 body photography (TBP) traditionally provides baseline images from which 6 macroscopic lesion changes can be detected, whereas digital epiluminescence 7 (dermatoscopic) microscopy reveals subtle changes in pre-existing nevi2.  Time 8 and cost barriers restrict the use of both modalities to a select group of high risk 9 patients in pigmented skin lesion clinics.   10      Automation of TBP using a 25 camera array enables the routine capture of 11 clinical images as an adjunct to the total body skin examination.  Computer-12 assisted comparison of serial images exposes new and changed lesions, which 13 are then photographed dermatoscopically 3.  We describe the clinical, 14 dermatoscopic and histopathological features of melanomas ≤ 3 mm in size 15 (micromelanomas) identified using this process.  16      We performed a retrospective study of 268 consecutive melanocytic lesions 17 biopsied from 218 patients, from January, 2015 through June, 2016 in a single 18 practice dermatology clinic.  Lesion diameter was obtained from dermatoscopic 19 images taken prior to biopsy and depth was obtained from pathology reports.   20      Eighty-one of 268 melanocytic lesions (30.22%) were in situ (MIS) or invasive 21 melanoma (range: 0.12, 3.5; median: 0.34), and 28 (34.57% of the melanomas) 22 were ≤ 3 mm in diameter; 27 (33.33%) were > 3 & ≤ 6 mm; and 26 (32.10%) were 23   5  > 6 mm. Of the lesions ≤ 3 mm, 21 (75.00%) were MIS and 7 (25.00%) were 24 invasive (range: 0.22 - 0.42; median 0.3 mm).  Of lesions > 3 and ≤ 6 mm, 13 25 (48.15%) were MIS and 14 (51.85%) were invasive (range: 0.2 - 2.3; median 26 0.395 mm).  Of lesions > 6 mm, 16 (61.54%) were MIS and 10 (38.46%) were 27 invasive (range: 0.12 - 3.5; median 0.38 mm). 28      Nineteen of the 28 micromelanomas (68%) had diameters ≤ 2 mm and were 29 sent for two additional blinded histopathologic assessments.  Eleven of these 30 (58%) were diagnosed as melanoma by all 3 dermatopathologists.  The remaining 31 eight lesions were called melanoma by one pathologist and severely atypical by 32 another with a comment that they could represent evolving melanoma and should 33 be excised.   34      Time-lapse clinical images and the corresponding dermatoscopic image of a 35 melanoma can be seen in Figure 1.  Dermatoscopic features of chaos, clods and 36 amorphous areas were identified in all malignant lesions, but our sample size is 37 not large enough to determine the relative value of each feature. 38      There are other reports of micromelanomas identified using various TBP and 39 dermoscopy platforms with yields in the range of 23 (11%) of 206 lesions 40 biopsied4, and 4 (4%) of 95 pigmented lesions biopsied5.  Compared to the 41 Abassi study, we found a significantly lower number needed to biopsy (3.1 vs 42 12.01), with a similar MIS:INV ratio (1.56:1).  These studies suggest that routine 43 comparison of complete sets of TBP images combined with dermatoscopy can 44 identify very small lesions of melanoma, some of which are already invasive.  45  46   6  References: 1 1.   Mocellin S, Nitti D. Cutaneous melanoma in situ: translational evidence from a  2       large population-based study. Oncologist. 2011;16:896-903. 3 2.  Goodson AG, Florell SR, Hyde M, Bowen GM, Grossman D. Comparative  4       analysis of total body and dermatoscopic photographic monitoring of nevi in  5       similar patient populations at risk for cutaneous melanoma. Dermatol Surg.  6       2010;36(7):1087-98. 7 3.   Rosendahl C, Drugge E, Volpicelli E, Drugge R. Diagnosis of a minute  8       melanoma assisted by automated multi-camera-array total body  9       photography.  Australasian J Dermatol. 2016;57(3):242-243. 10 4.  Bono A, Tolomio E, Trincone S, Bartoli C, Tamatis S, Carbone A, Santinami M. Micro- 11       melanoma detection: a clinical study on 206 consecutive cases of pigmented skin  12       lesions with a diameter of ≤ 3 mm.  Br J Dermatol. 2006;155:570-573. 13 5.  Abbasi NR, Yancovitz M, Gutkowicz-Krusin D, Panageas KW, Mihm MC, Googe P, King  14       R, Prieto V, Osman I, Friedman RJ, Rigel DS, Kopf AW, Polsky D. Utility of lesion  15       diameter in the clinical diagnosis of cutaneous melanoma. Arch Dermatol.  16       2008:144(4):469-474.  17  18  19  20  21   7  Figure Legend: 1 Fig. 1. Malignant melanoma.  Time-lapse total body clinical images exhibited a new lesion 2 that appeared within 1 year and 3.5 months.  The corresponding dermatoscopic image 3 revealed a lesion that measured 1.7 mm in diameter (using the dermatoscope scale), 4 with features of chaos, clods and amorphous areas. 5  6  7 

Micromelanomas Identified with Time-Lapse Total Body Photography and Dermoscopy

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Micromelanomas Identified with Time-Lapse Total Body Photography and Dermoscopy

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