Extensive regression in pigmented skin lesions: a dangerous confounding feature

  • Lallas A
  • Apalla Z
  • Moscarella E
  • et al.
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Abstract

Spontaneous regression in melanomas is not an uncommon phenomenon, as it has been described in 10-35% of primary cutaneous lesions [1]. Regression does not appear to predict a more favorable course, since even fully regressed melanomas may progress into metastatic disease [2]. Several dermoscopic features have been correlated with the regression process, including white scar-like depigmented areas and gray-blue, pepper-like granules, which correspond to dermal scarring, pigment incontinence and presence of melanophages [3,4]. Regression may occur not only in melanomas, but also in melanocytic nevi, which similarly may exhibit white areas and gray-blue granules or areas under dermoscopy [5]. Overall, white areas have been proposed to be associated with the fibrosis type of regression and gray-blue areas to the melanosis type of regression of melanocytic tumors [3]. Lichen planus like keratosis (LPLK) is considered to represent a regressed solar lentigo or seborrheic keratosis. Dermoscopy of LPLK at the late stage of the regression process reveals a diffuse gray-blue granular pattern, similar to that observed in regressed melanocytic lesions [6]. In this context, when evaluating skin lesions that exhibit high degree of regression, interpretation of dermoscopic findings may be problematic, especially when no other dermoscopic clues can be recognized.

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Lallas, A., Apalla, Z., Moscarella, E., Zalaudek, I., Tzellos, T., Lefaki, I., … Argenziano, G. (2012). Extensive regression in pigmented skin lesions: a dangerous confounding feature. Dermatology Practical & Conceptual, 2(2). https://doi.org/10.5826/dpc.0202a08

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