10.5826/dpc.1204a209
text/xml
2160-9381
2123
en
Oriol Yélamos
https://creativecommons.org/licenses/by-nc/4.0
Dermatology Practical & Conceptual
synchronous melanomas
Five synchronous melanomas: role of dermoscopy as a triage tool to manage melanoma during the COVID-19 pandemic
Text.Serial.Journal
https://dpcj.org/index.php/dpc
Research Letter
2022-10-31
2021-10-25
2022-10-31
2022-12-05
e2022209
Dermatol Pract Concept
Oriol Yélamos
2022/10/31
10.5826/dpc.1204a209
e2022209
Department of Dermatology, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
2160-9381
synchronous melanomas
en
e2022209
Five synchronous melanomas: role of dermoscopy as a triage tool to manage melanoma during the COVID-19 pandemic
https://dpcj.org/index.php/dpc/article/download/2123/1793
 Five Synchronous Melanomas: Role of Dermoscopy
    as a Triage Tool to Manage Melanoma During
               the COVID-19 Pandemic
          Carla Tubau1, Lluís Rusiñol1, Guillermo Sánchez-Rodríguez1, Helena Iznardo1,
                           Victoria Amat-Samaranch1, Oriol Yélamos1


1 Department of Dermatology, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain



Key words: COVID-19, dermoscopy, management, in situ melanoma, synchronous melanomas
Citation: Tubau C, Sánchez-Rodríguez G, Iznardo H, Amat-Samaranch V, Yélamos O. Five synchronous melanomas: role of dermoscopy
as a triage tool to manage melanoma during the COVID-19 pandemic. Dermatol Pract Concept. 2022;12(4):e2022209. DOI: https://doi.
org/10.5826/dpc.1204a209
Accepted: January 5, 2022; Published: October 2022
Copyright: ©2022 Tubau et al. This is an open-access article distributed under the terms of the Creative Commons Attribution-
NonCommercial License (BY-NC-4.0), https://creativecommons.org/licenses/by-nc/4.0/, which permits unrestricted noncommercial use,
distribution, and reproduction in any medium, provided the original authors and source are credited.
Funding: None.
Competing interests: OY has received honoraria from BMS (speakers honoraria), and MSD (speakers honoraria). The other authors declare
no conflicts of interest.
Authorship: All authors have contributed significantly to this publication.
Corresponding author: Carla Tubau, MD, Department of Dermatology, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de
Barcelona, Mas Casanovas 90, 08041 Barcelona, Spain, Phone: (+34) 935537007, Fax (+34) 935537008. E-Mail: ctubau@santpau.cat




Introduction                                                             COVID-19 pandemic, we face challenging cases that need to
                                                                         be managed with fewer visits than usual.
Multiple meta-analyses have shown that dermoscopy is
more accurate than the naked eye in melanoma diagnosis
                                                                         Case Presentation
[1]. Since dermoscopy has direct histopathological cor-
relates, it can be used to triage and manage pigmented le-               An 89-year-old man with multiple comorbidities, ECOG 3,
sions [2]. Certain colors under dermoscopy such as blue over             was referred for evaluation of a nasal pigmented lesion. Previ-
raised areas are indicators of deep melanin, whereas on flat             ous biopsies did not reveal malignancy but he referred enlarge-
surfaces may indicate regression [2]. Furthermore, certain               ment over time. A brown-black 2.5 cm-patch with ill-defined
structures indicate melanoma invasion such as shiny white                borders covered patient’s central nasal dorsum (­Figure 1A).
streaks or blue-whitish veil [2]. Hence, when large lesions are          Dermoscopy showed asymmetric pigment around follicles,
challenging to be excised completely, these areas suspicious             peppering, angulated lines, and areas of follicle invasion
for invasion under dermoscopy such as raised blue-gray ar-               (­Figures 1, B, C and D). A complete cutaneous examination
eas could be sampled in order to maximize the histologic re-             was performed identifying four further suspicious lesions. One
sults. Moreover, dermoscopy also allows the identification of            black 2.1 x 1 cm macule on the chest (Figure 2A) showing
small invasive melanomas thus improving its management.                  peripheral streaks asymmetrically distributed and a central
During our daily practice, currently in the middle of the                blue-whitish veil on dermoscopy (­Figure 2B). One elongated



Research Letter | Dermatol Pract Concept. 2022;12(4):e2022209                                                                         1
Figure 1. (A) Clinical image of the nasal dorsum pigmented lesion consisting of a brown-black 2.5cm patch with ill-defined borders that cov-
ers the central nasal dorsum. (B-D) Dermoscopy images showing asymmetric pigmented follicular openings (arrows), angulated or polygonal
lines (arrowheads), blue-gray dots or peppering (asterisk), and areas of follicle invasion (circles).




Figure 2. (A) Clinical image of the 2.2 x 2 cm macule on the chest. (B) Dermoscopic image showing peripheral streaks asymmetrically dis-
tributed and central blue-whitish veil. (C) Clinical image of the pigmented lesion on the neck, which presented as an elongated brown-black
macule of 1.4 x 0.8 cm. (D) Dermoscopy of the neck lesion where atypical pigmented network and an irregular black blotch at the periphery
can be observed. (E) Clinical image of the upper dorsum brown to black 0.5 x 0.3 cm macule. (F) Upper dorsum lesion dermoscopy showing
an atypical brown network. (G) Clinical image of the pigmented lesion on the right shoulder presented as a brown-black 0.7 x 0.6 cm macule.
(H) Atypical brown network and inferior-left homogeneous brown area on dermoscopy of the shoulder lesion.




2                                                                           Research Letter | Dermatol Pract Concept. 2022;12(4):e2022209
brown to black 1.4 x 0.8 cm macule on the neck (Figure 2C),     Breslow index (chest lesion). Wide local excision was later
with an atypical pigmented network and an irregular black       performed in all lesions according to the current guidelines.
blotch on dermoscopy (Figure 2D). A brown to black 0.5          The patient is alive with no signs of active disease.
x 0.3 cm macule on the upper dorsum showing an atypical
brown network on dermoscopy (Figures 2, E and F). Ulti-
                                                                Conclusions
mately, a brown to black 0.7 x 0.6 cm macule on his right
shoulder, with an atypical brown network and an inferior-left   We present an unusual case of a man with five synchronous
homogenous brown area on dermoscopy (Figures 2, G and H).       primary melanomas, whose management was streamlined
   Given the number of lesions suggesting melanoma and          thanks to dermoscopy. Hence, by using dermoscopy we
considering the patient comorbidities, a shave-excision was     could simplify the patient flow and minimize the number
performed during the same initial appointment of the smaller    of appointments, especially useful in the current context of
lesions suspected to be in situ by dermoscopy (atypical net-    COVID-19 pandemic.
work with absence of blue-gray color, shiny white structures
or vessels): the shoulder and upper dorsum lesions. The
patient was scheduled for complete excision of the chest
                                                                References
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                                                                 2. Yélamos O, Braun RP, Liopyris K, et al. Dermoscopy and derma-
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   Results from histologic examination yielded four in
situ melanomas, and an invasive melanoma with a 0.6 mm




Research Letter | Dermatol Pract Concept. 2022;12(4):e2022209                                                                  3
