Can You Use Dermoscopy to Detect Breslow Thickness in Acral Melanomas?

Acral melanomas (AM) are often misdiagnosed or there is a delay to appropriate diagnosis, leading to a possible delay in treatment and a corresponding poorer prognosis. Dermoscopy can be helpful for early detection by differentiating AM from benign acral melanocytic nevi. While depth of invasion is the most critical prognostic factor, a recent study hypothesized that Breslow thickness (BT) may be better characterized through dermoscopic findings and may have an impact on prognosis and treatment of AM.

The authors state that BT is a significant prognostic factor itself and affects the margin size during surgical excision. Therefore, it is critical to get an accurate pre-operative prediction of BT. The study investigated the association of BT with the dermoscopic features of AM. The results showed that there are distinctive patterns between in situ and invasive AM. Early stage AM showed features such as asymmetry, parallel ridge pattern (PRP), irregular dots and globules, and irregular blotches. More invasive cases also showed asymmetry and PRP, but there were more frequent occurrences of irregular blotches, polychromia, ulcers, blue-white veils, and atypical vascular patterns. Specific colors (white, blue, red) were also seen more frequently with invasive melanomas. As the BT increased, so did atypical vascular patterns, blue-white veils, and ulcers.

The authors conclude that there were distinguishing dermoscopic patterns among AM according to tumor thickness. They state that preoperative clinical examinations using dermoscopy have the potential to enhance diagnostic accuracy and management for AM, and dermoscopy can be a useful supplemental device for the prediction of Breslow thickness.