Dermoscopy of black skin: A cross-sectional study of clinical and dermoscopic features of melanocytic lesions in individuals with type V/VI skin compared to those with type I/II skin

doi:10.1016/j.jaad.2015.03.043

Journal of the American Academy of Dermatology

Volume 73, Issue 1, July 2015, Pages 114-119

https://doi.org/10.1016/j.jaad.2015.03.043 Get rights and content

Background

The identification of “normal” dermoscopic patterns of acquired melanocytic nevi provides better diagnostic accuracy for melanoma in people with black skin.

Objective

We sought to describe melanocytic lesions (numbers and anatomic distributions) in skin types V and VI compared with skin types I and II, according to the Fitzpatrick classification. We sought to identify differences in dermoscopic findings in acquired melanocytic nevi (global pattern, pigment and color distribution) between the groups.

Methods

We conducted cross-sectional, prospective, and consecutive data collection in 2 dermatologic outpatient clinics, between October 8, 2010, and March 20, 2013. From the 501 volunteers, 480 participants fulfilled the eligibility criteria. A total of 460 acquired melanocytic nevi were selected for dermoscopic analysis.

Results

Individuals with skin type V/VI had fewer melanocytic lesions than those with skin type I/II (15.08 vs 7.90; P = .032), and the anatomic distribution in the first group was predominantly on the face and acral sites (P < .001). The acquired melanocytic nevi in the skin type V/VI group were associated with the reticular pattern (P < .0001), with a tendency toward central hyperpigmentation (P = .0025).

Limitations

The choice of a single representative nevus per patient is a limitation.

Conclusions

Acquired melanocytic nevi in individuals with skin type V/VI have a distinct dermoscopic pattern from those with skin type I/II.

Section snippets

Methods

This is a cross-sectional study with prospective and consecutive data collection in 2 different centers (Federal University of São Paulo and State University of Londrina) that was carried out between October 2010 and March 2013. Data were collected by a single dermoscopy expert. All of the patients provided written informed consent, and the ethics committee of both institutions involved approved the study.

Patient screening took place in dermatologic outpatient clinics, to be representative of

Results

From the 501 volunteers, 480 (95.8%) met the criteria for clinical analysis. In all, 21 volunteers were excluded because of tanned skin or recent sun exposure. Of the 480 participants, 460 (95.83%) had eligible melanocytic nevi, and 11 participants were excluded from the dermoscopic analysis because of the presence of melanocytic lesions only in special anatomic sites (face and acral site); 9 were excluded because they showed no lesions. No patients were excluded because of the poor quality of

Discussion

This study examined the differences in dermoscopic analysis (global, pattern, pigment distribution, and color) between skin types V/VI and I/II. To our knowledge, this is the first study that compares these 2 groups and includes a large number of individuals. Furthermore, we observed differences in the number and anatomic distribution of melanocytic lesions between these 2 groups.

In the study of Zalaudek et al,¹¹ dermoscopic analysis revealed significant differences in the prevalent nevus

References (26)

H. Pehamberger et al.
In vivo epiluminescence microscopy of pigmented skin lesions. I. Pattern analysis of pigmented skin lesions
J Am Acad Dermatol
(1987)
A. Steiner et al.
In vivo epiluminescence microscopy of pigmented skin lesions. II. Diagnosis of small pigmented skin lesions and early detection of malignant melanoma
J Am Acad Dermatol
(1987)
M.L. Bafounta et al.
Is dermoscopy (epiluminescence microscopy) useful for the diagnosis of melanoma? Results of a meta-analysis using techniques adapted to the evaluation of diagnostic tests
Arch Dermatol
(2001)
M.E. Vestergaard et al.
Dermoscopy compared with naked eye examination for the diagnosis of primary melanoma: a meta-analysis of studies performed in a clinical setting
Br J Dermatol
(2008)
P. Carli et al.
Improvement of malignant/benign ratio in excised melanocytic lesions in the dermoscopy era: a retrospective study 1997–2001
Br J Dermatol
(2004)
G. Argenziano et al.
Dermoscopy improves accuracy of primary care physicians to triage lesions suggestive of skin cancer
J Clin Oncol
(2006)
T.B. Fitzpatrick
Soleil et peau
J Med Esthet
(1975)
Howlader N, Noone AM, Krapcho M, et al, eds. SEER Cancer Statistics Review, 1975-2012. National Cancer Institute:...
P.T. Bradford et al.
Acral lentiginous melanoma. Incidence and survival patterns in the United States, 1986-2005
Arch Dermatol
(2009)
S. Hu et al.
UV radiation, latitude, and melanoma in US Hispanics and blacks
Arch Dermatol
(2004)

X.C. Wu et al.

Racial and ethnic variations in incidence and survival of cutaneous melanoma in the United States, 1999-2006

J Am Acad Dermatol

(2011)

V. Giorgi et al.

Dermoscopy in black people

Br J Dermatol

(2006)

I. Zalaudek et al.

Nevus type in dermoscopy is related to skin type in white persons

Arch Dermatol

(2007)

Cited by (20)

Melanoma in skin of color: Part I. Epidemiology and clinical presentation
2023, Journal of the American Academy of Dermatology
Although there is a higher incidence of melanoma among non-Hispanic White individuals, melanoma is diagnosed at more advanced stages and associated with worse survival rates among individuals with skin of color (SOC). The proportions of melanoma subtypes differ across racial groups, with acral lentiginous melanoma and mucosal melanoma representing higher proportions of melanoma diagnoses in individuals with SOC compared to White individuals. The recognition of distinct differences in anatomic locations and dermatoscopic patterns may facilitate the appropriate differentiation of physiologic from pathologic pigmentation. The first article of this continuing medical education series will focus on the epidemiology and clinical presentation of melanoma in individuals with SOC, with the aim of improving early diagnoses and clinical outcomes.
Dermoscopic features of neoplasms in skin of color: A review
2021, International Journal of Women's Dermatology
Citation Excerpt :
In both fair skin and SoC, uniform distribution of pigment is most commonly seen in acquired nevi. However, multifocal areas of hyper- and/or hypopigmentation in nevi are more commonly seen in fairer-skinned patients, whereas a darker background with central hyperpigmentation is more common in SoC (Tuma et al., 2015). Studies have also found an increased frequency of reticular pattern in nevi of darker skin phototypes (Scope et al., 2008; Sosa-Seda et al., 2014).
Dermoscopy is undoubtedly a useful tool to improve diagnostic accuracy and minimize the number of unnecessary biopsies. However, much of the literature on dermoscopy focuses on findings in lighter-skin phototypes, leaving potential gaps of knowledge regarding its use in skin of color (SoC). As the clinical applications of dermoscopy continue to increase, understanding dermoscopic patterns in SoC is imperative.
This review discusses the literature on dermoscopic findings of neoplasms in SoC, highlighting unique and characteristic dermoscopic features.
A literature review was performed using the PubMed database. Case reports, case series, case-control studies, and systematic reviews were included.
A total of 8326 studies were identified based on the selected search terms, and 41 were included in this review based on relevance.
There are specific dermoscopic characteristics in SoC for benign nevi, acral lentiginous melanoma, ethnic melanonychia, and dermatofibroma; however, there is a lack of published data about specific features of cutaneous melanoma, subungual melanoma, pigmented basal cell carcinoma, and pigmented squamous cell carcinoma in SoC. Because pigmented basal cell carcinoma, pigmented squamous cell carcinoma, ethnic melanonychia, and acral lentiginous melanoma are diagnosed at later stages in this population, it is important to understand their dermoscopic features. Further descriptive studies are needed to better characterize unique dermoscopic features in neoplasms in SoC.
JAAD Game Changers: Dermoscopy of black skin: A cross-sectional study of clinical and dermoscopic features of melanocytic lesions in individuals with type V/VI skin compared to those with type I/II skin
2020, Journal of the American Academy of Dermatology
Ultraviolet Radiation Exposure and Its Impact on Skin Cancer Risk
2016, Seminars in Oncology Nursing
Citation Excerpt :
Skin tone and nevi count are also somewhat associated; studies show that children with light skin, pales eyes, freckles, and a tendency to sunburn have a significantly higher nevi count.20 In addition, patterns of nevi differ by skin type, both by site on the body and by cell type.21 Melanoma incidence and mortality rates are highest among non-Hispanic whites because of their typically lighter skin tone.
To review research and evidence-based resources on skin cancer prevention and early detection and their importance for oncology nurses.
Journal articles, federal reports, cancer surveillance data, behavioral surveillance data.
Most cases of skin cancer are preventable. Survivors of many types of cancer are at increased risk of skin cancers.
Oncology nurses can play an important role in protecting their patients from future skin cancer morbidity and mortality.
Acral melanocytic lesions in the United States: Prevalence, awareness, and dermoscopic patterns in skin-of-color and non-Hispanic white patients
2016, Journal of the American Academy of Dermatology
Citation Excerpt :
Our study cohort included all ethnicities presenting to dermatology clinics in diverse populations of New York City and Miami, including many Hispanic skin-of-color patients, which may explain the higher number of lesions observed. Prior studies suggest that acral lesions are more common in skin-of-color than white patients.25 Our data support this finding among a large, multi-institutional cohort examined prospectively.
Acral lentiginous melanoma has increased mortality compared with other melanoma subtypes and disproportionately affects ethnic minorities. Acral melanocytic lesions have not been well studied in diverse populations of the United States.
We sought to assess the prevalence, awareness, and dermoscopic patterns of acral melanocytic lesions in skin-of-color and non-Hispanic white patients.
We prospectively examined the palms and soles of 1052 patients presenting to dermatology clinics in New York, NY, and Miami, FL, from October 2013 to April 2015.
Acral melanocytic lesions were observed in 36% of our cohort. Skin-of-color patients were more likely to have acral melanocytic lesions than non-Hispanic white patients (P < .01). Acral melanocytic lesions correlated with increased mole counts, particularly on non-Hispanic white patients. The majority of lesions demonstrated benign dermoscopic patterns. We observed 2 lesions with the parallel ridge pattern in our cohort, both found to be atypical nevi on biopsy specimen. Patients often lacked awareness of the presence of their lesions.
Interobserver variability in assessing dermoscopic patterns is a limitation.
Melanocytic lesions of the palms and soles are common, particularly in a cohort of multiple ethnicities from the United States. Dermoscopy of acral lesions is an important clinical tool for diagnosis and management of these lesions.
Prevalence and onychoscopy features of benign longitudinal melanonychia in richly pigmented skin individuals
2024, Journal of the Egyptian Women's Dermatologic Society

View all citing articles on Scopus

: Funding sources: None.

: Conflicts of interest: None declared.

View full text

Original articleDermoscopy of black skin: A cross-sectional study of clinical and dermoscopic features of melanocytic lesions in individuals with type V/VI skin compared to those with type I/II skin

Background

Objective

Methods

Results

Limitations

Conclusions

Section snippets

Methods

Results

Discussion

J Am Acad Dermatol

J Am Acad Dermatol

Is dermoscopy (epiluminescence microscopy) useful for the diagnosis of melanoma? Results of a meta-analysis using techniques adapted to the evaluation of diagnostic tests

Arch Dermatol

Dermoscopy compared with naked eye examination for the diagnosis of primary melanoma: a meta-analysis of studies performed in a clinical setting

Br J Dermatol

Improvement of malignant/benign ratio in excised melanocytic lesions in the dermoscopy era: a retrospective study 1997–2001

Br J Dermatol

Dermoscopy improves accuracy of primary care physicians to triage lesions suggestive of skin cancer

J Clin Oncol

Soleil et peau

J Med Esthet

Acral lentiginous melanoma. Incidence and survival patterns in the United States, 1986-2005

Arch Dermatol

UV radiation, latitude, and melanoma in US Hispanics and blacks

Arch Dermatol

Racial and ethnic variations in incidence and survival of cutaneous melanoma in the United States, 1999-2006

J Am Acad Dermatol

Dermoscopy in black people

Br J Dermatol

Nevus type in dermoscopy is related to skin type in white persons

Arch Dermatol

Original article
Dermoscopy of black skin: A cross-sectional study of clinical and dermoscopic features of melanocytic lesions in individuals with type V/VI skin compared to those with type I/II skin