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Pushing and loss of elastic fibers are highly specific for melanoma and rare in melanocytic nevi

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Abstract

The histopathological differentiation of melanocytic nevi from malignant melanoma (MM) is based on well-known criteria, and is straightforward in the vast majority of cases. However, there are few cases of melanocytic lesions (ML), the diagnosis of which is very challenging or even impossible. Here we have studied several morphological characteristics with particular focus on elastic fibers (EF) to identify features, helpful for the distinction between nevi and MM. In a monocentric retrospective study we have analyzed 14 morphological histological characteristics in 30 MMs and 90 nevi, encompassing 30 compound/dermal nevi, 30 junctional nevi, 30 dysplastic nevi. All consecutive cases were retrieved from the archives of our tertiary referral centre during the 6-month study period. Nine characteristics including loss of EF in the ML, loss of EF in lesional fibrosis, pushing of the EF, UV-elastosis, loss of rete ridges of the epidermis, regression of the ML, atrophy of the epidermis, pigment incontinence, and concentric eosinophilic fibroplasia (CEF) showed a statistical significant difference (p < 0.05 and at least an OR > 2) distinguishing nevi from MM. Loss of EF was found in 73.1% of MM cases, but in less than 2.5% of nevi. We identified nine morphological characteristics that are helpful to differentiate melanocytic nevi from MM. A loss of the EF in a ML appeared to be highly associated with MM.

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Acknowledgements

We are thankful to the laboratory technicians Miss Lyn Rutz, and Miss Lolita Quinto for the great support with the special stains, to Miss Miriam Elias for preparing the pictures, and to Mister Mark Wienand for the revision of the language.

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Authors and Affiliations

  1. Dermatology Department, Inselspital Bern University Hospital, University of Bern, Freiburgstrasse, 3010, Bern, Switzerland

    A. Stillhard, S. Cazzaniga, L. Borradori & Helmut Beltraminelli

  2. Centro Studi GISED, Bergamo, Italy

    S. Cazzaniga

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  2. S. Cazzaniga
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  4. Helmut Beltraminelli
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AS: all analyses, literature review, manuscript. SC: statistics, manuscript. LB: literature, manuscript. HB: study design, all analyses, literature review, manuscript.

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Correspondence to Helmut Beltraminelli.

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Reviewed and approved by the ethics committee of the Canton of Bern, Switzerland (KEK-229/14).

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Stillhard, A., Cazzaniga, S., Borradori, L. et al. Pushing and loss of elastic fibers are highly specific for melanoma and rare in melanocytic nevi. Arch Dermatol Res 311, 99–107 (2019). https://doi.org/10.1007/s00403-018-1885-x

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  • DOI: https://doi.org/10.1007/s00403-018-1885-x

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