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Original Investigation |

Comparison of Ex Vivo and In Vivo Dermoscopy in Dermatopathologic Evaluation of Skin Tumors

Marc Haspeslagh, MD1,2; Katrien Vossaert, MD3; Sven Lanssens, MD3; Michael Noë, MD1; Isabelle Hoorens, MD2; Ines Chevolet, MD2; Ine De Wispelaere, BA1; Nele Degryse, BA1; Fabio Facchetti, MD, PhD4; Lieve Brochez, MD, PhD2
[+] Author Affiliations
1Dermpat, Ardooie, Belgium
2Department of Dermatology, University Hospital, Ghent, Belgium
3currently in private practice in Maldegem, Belgium
4Department of Pathology, Spedali Civili, Brescia, Italy
JAMA Dermatol. 2016;152(3):312-317. doi:10.1001/jamadermatol.2015.4766.
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Importance  Ex vivo dermoscopy (EVD) can be a valuable tool in routine diagnostic dermatopathologic evaluation.

Objectives  To compare in vivo dermoscopy (IVD) and EVD and to provide guidance for routine dermatopathologic evaluations.

Design, Setting, and Participants  This observational study collected 101 consecutive IVD and EVD images of skin tumors from a private dermatology practice from March 1 to September 30, 2013. Four observers (3 dermatologists and 1 dermatopathologist) blinded to the histopathologic diagnoses independently scored and compared the colors, structures, and vessels of EVD images with those of the corresponding IVD images. Data were analyzed from January 1 to March 31, 2014.

Main Outcomes and Measures  Concordance between the EVD and IVD images and gain or loss of colors, structures, and vessels on EVD relative to IVD images.

Results  The final analysis included 404 observations of 101 images. The EVD image was generally similar to the corresponding IVD image but clearly darker, with new areas of blue in 130 of 404 observations (32.2%) and white in 100 of 404 observations (24.8%) and loss of red in 283 of 404 observations (70.0%). Most structures were well preserved. New structureless areas were found in 78 of 404 observations of EVD images (19.3%), and new crystalline structures were detected in 68 of 404 observations of EVD images (16.8%). On EVD images, squames and crusts were lost in 56 of 404 observations (13.9%) and 43 of 404 observations (10.6%), respectively. Blood vessels were lost in 142 of 404 observations of EVD images (35.1%).

Conclusions and Relevance  The EVD image is an important new tool in dermatopathology and may give direction to targeted tissue processing and examination of skin tumors.

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Figure 1.
Example of Basal Cell Carcinoma (BCC)

The nodular type BCC was located on the back of a man in his 40s. The vessels were partly preserved on ex vivo dermoscopy as light brown curved and branched lines. The ex vivo dermoscopic image showed a new white crystalline structureless area that created a sharper delineation of the tumor compared with the in vivo dermoscopic image.

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Figure 2.
Example of Melanoma

The lesion (Breslow thickness, 0.5 mm) was located on the abdomen of a woman in her 60s. A new blue area on the ex vivo dermoscopic image disclosed the only invasive area in this melanoma.

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Figure 3.
Example of Spitz Nevus

The lesion was located on the right upper arm of a girl in her teens. A large new blue veil was seen on the ex vivo image.

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The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
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