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Dermatologic Clinics

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HISTOPATHOLOGIC CORRELATES OF DERMOSCOPIC CRITERIA - 03/09/11

Doi : 10.1016/S0733-8635(05)70264-3 
Daniela Massi, MD a, Vincenzo De Giorgi, MD b, H. Peter Soyer, MD c
a Department of Human Pathology and Oncology (DM) 
b Dermatology (VDG), University of Florence, Florence, Italy 
c Department of Dermatology, University of Graz, Graz, Austria (HPS) 

Résumé

Recently, the use of dermoscopy has substantially improved the diagnostic accuracy in pigmented tumors of the skin.7, 9, 10, 11, 12, 13, 15, 18, 19, 20, 21, 22, 23 This technique combines oil immersion applied to the surface of pigmented lesions with magnifying optics to visualize morphologic features not otherwise discernible by the naked eye. The correct interpretation of such dermoscopic features requires not only familiarity with the basic histology of the skin but also an understanding of the corresponding histopathologic correlates. Clinicopathologic correlation is essential for the dermatologist to further refine and standardize dermoscopic criteria. In contrast, the diagnostic accuracy of the histopathologic examination, especially for equivocal cases, may be enhanced by considering particular dermoscopic findings of a given pigmented lesion.

To date, only a few studies have focused on the histopathologic correlates of structures seen in dermoscopy.5, 14, 16, 17, 24 It is well known that dermoscopic features of pigmented skin lesions result from specific alterations of the epidermis, dermoepidermal junction, and papillary dermis4, 5, 8, 14, 17; however, the fact that dermoscopic features are seen in the horizontal plane, whereas the histopathologic sections are vertically oriented, represents one of the major difficulties in performing an exact dermoscopic-pathologic correlation.

In 1989, Soyer et al17 published one of the first studies to correlate various dermoscopic features with the corresponding histopathologic findings in step-sectioned specimens. In this study, the histologic counterpart of several dermoscopic parameters, including pigment network, black dots, and irregular extensions, were illustrated.17 Subsequently, Yadav et al24 confirmed some of the previous observations and identified histologic correlates of additional features such as brown globules, hypopigmented areas, white areas, gray-blue areas, and whitish veils through careful step sectioning of melanocytic skin lesions. In the study by Yadav, dermoscopic images were depicted simultaneously with the histopathologic images to visualize the exact histologic correlates of each dermoscopic feature24; however, in their report, Yadav and coworkers did not present a case-by-case correlation but showed the best clinical and dermoscopic examples of a given dermoscopic feature and of the histologic correlate, not necessarily from the very same case.24 A more refined and accurate approach to obtaining exact clinicopathologic correlation was recently described by Soyer et al.16 In this study, skin specimens were processed using a meticulous protocol of gross pathology and viewed along with clinical photographs and digitally magnified dermoscopic images. By digitally enhancing dermoscopic images, dermoscopic features could be located more precisely and correlated with the corresponding histopathologic findings. This approach allowed recognition of the histologic correlates of a few not yet fully characterized dermoscopic structures such as black lamellae, radial streaks, and exophytic papillary structures.16

These basic studies, along with a few other observations, outline the histologic structures underlying most dermoscopic criteria (Table 1). Each dermoscopic feature is described extensively.

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 Address reprint requests to H. Peter Soyer, MD Department of Dermatology University of Graz Auenbruggerplatz 8 A-8036 Graz Austria peter.soyer@uni-graz.at


© 2001  W. B. Saunders Company. Publié par Elsevier Masson SAS. Tous droits réservés.
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Vol 19 - N° 2

P. 259-268 - avril 2001 Retour au numéro
Article précédent Article précédent
  • INTRODUCTION TO DERMOSCOPY
  • Brian Katz, Harold S. Rabinovitz
| Article suivant Article suivant
  • TYPICAL DERMOSCOPIC PATTERNS OF BENIGN MELANOCYTIC NEVI
  • Babar K. Rao, Steven Q. Wang, Frank P. Murphy

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