Original Investigation |

Ex Vivo Dermoscopy for Biobank-Oriented Sampling of Melanoma

Joseph Malvehy, MD1,2; Paula Aguilera, MD1; Cristina Carrera, MD1; Gabriel Salerni, MD, PhD1; Louise Lovatto, MD1; Alon Scope, MD3,4; Ashfaq A. Marghoob, MD3; Josep Palou, MD1,5; Llúcia Alós, MD5; Susana Puig, MD1,2
[+] Author Affiliations
1Melanoma Unit, Department of Dermatology, Hospital Clinic, Institut d’Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spain
2Centro de Investigacion Biomedica en Red Enfermedades Raras, Instituto de Salud Carlos III, Barcelona, Spain
3Dermatology Service, Memorial Sloan-Kettering Cancer Center, New York, New York
4Department of Dermatology, Sheba Medical Center, and Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
5Melanoma Unit, Department of Pathology, Hospital Clinic, Institut d’Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spain
JAMA Dermatol. 2013;149(9):1060-1067. doi:10.1001/jamadermatol.2013.4724.
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Importance  In the era of targeted therapy for cancer, translational research identifying molecular targets in melanoma offers novel opportunities for potential new treatments.

Objectives  To describe a method for sampling fresh tissue from primary melanoma and to test whether the area of maximal thickness can be identified with dermoscopy to ensure it remains available for routine histopathological diagnosis.

Design, Setting, and Participants  Tumors clinically suspicious for melanoma with diameter exceeding 5 mm were included. Dermoscopy-guided sampling was performed using a 2-mm to 3-mm punch through not the thickest part of the tumor. In vivo and ex vivo dermoscopic images obtained were available to the diagnosing pathologist. Melanoma samples were obtained in a referral melanoma unit.

Main Outcomes and Measures  In study 1, Breslow thickness in 10 melanomas was compared between sampled tissue and the remaining specimen to confirm that the area of maximal thickness remained available for the histopathological diagnosis. In study 2, forty-three additional melanomas were sampled for biobanking prospectively. Agreement between 2 independent observers on dermoscopic identification of the thickest part of the melanoma was studied.

Results  In study 1, the area of maximal Breslow thickness in all 10 melanomas was not sampled and remained in the main specimen. In study 2, sampling was performed by one of the investigators. Concordance was 93% between 2 independent observers for the dermoscopic selection of the thickest portion of the melanoma. Pathologists asserted that the sampling procedure did not compromise their ability to evaluate melanoma specimens. A limitation is that this is a single-center study. Each case required joint evaluation by expert dermoscopists and dermatopathologists.

Conclusions and Relevance  In applying the dermoscopy-guided sampling protocol, we make the following 5 recommendations: Samples should only be obtained from areas that will not interfere with the pathologist’s diagnosis and prognostic information. Sampling should not be obtained from tumors for which one suspects that the histopathological evaluation may prove difficult. Sampling should not be performed on small melanomas; we recommend a minimum diameter of 10 mm. All the dermoscopy-guided sampling should be documented with images, available to pathologists and clinicians, and reflected in the pathology report. Finally, the frozen biobank samples should be made available for routine hematoxylin-eosin histopathological evaluation until the final pathology report is produced. Ex vivo dermoscopy may serve to guide the procurement of small samples from primary melanoma for fresh tissue biobanking without compromising the histopathological evaluation.

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Place holder to copy figure label and caption
Superficial Spreading Melanoma (Breslow Thickness of 0.60 mm and Clark Level II) 18.9 mm in Maximal Diameter

A, In vivo dermoscopy (original magnification ×10). B, Ex vivo dermoscopic image of 4 dermoscopy-guided samples (2-mm punch), 2 of them for the histopathological correlation (the one on the left corresponds to dermoscopy in E and histological findings in F, and the one on the right corresponds to dermoscopy in H and histological findings in G). The 2 punch biopsies in the center were frozen and placed in the tissue bank. C, Dermoscopic mapping of the melanoma. D, Location of tissue sampling from within the melanoma. E, Ex vivo dermoscopic image with an atypical pigmented network with thick dark lines and a blue hue. F, Correlates on histopathological examination with a junctional proliferation of atypical melanocytes as solitary units and small nests and with the presence of melanophages in the superficial dermis (hematoxylin-eosin, original magnification ×100). G, Histopathological correlation of the area in H reveals nests of atypical melanocytes in the epidermis and along the dermoepidermal junction (hematoxylin-eosin, original magnification ×100). H, Ex vivo dermoscopic image of an area that exhibits brown globules with a negative network.

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