Background: The differential diagnosis of atypical melanocytic palmoplantar skin lesions (aMPLs) represents a diagnostic challenge, including atypical nevi (AN) and early melanomas (MMs) that display overlapping clinical and dermoscopic features. We aimed to set up a multicentric dataset of aMPL dermoscopic cases paired with multiple anamnestic risk factors and demographic and morphologic data. Methods: Each aMPL case was paired with a dermoscopic and clinical picture and a series of lesion-related data (maximum diameter value; location on the palm/sole in 17 areas; histologic diagnosis; and patient-related data (age, sex, family history of melanoma/sunburns, phototype, pheomelanin, eye/hair color, multiple/dysplastic body nevi, and traumatism on palms/soles). Results: A total of 542 aMPL cases—113 MM and 429 AN—were collected from 195 males and 347 females. No sex prevalence was found for melanomas, while women were found to have relatively more nevi. Melanomas were prevalent on the heel, plantar arch, and fingers in patients aged 65.3 on average, with an average diameter of 17 mm. Atypical nevi were prevalent on the plantar arch and palmar area of patients aged 41.33 on average, with an average diameter of 7 mm. Conclusions: Keeping in mind the risk profile of an aMPL patient can help obtain a timely differentiation between malignant/benign cases, thus avoiding delayed and inappropriate excision, respectively, with the latter often causing discomfort/dysfunctional scarring, especially at acral sites.

Citation: Cappilli S, Ribero S, Cornacchia L, et al. Melanocytic Lesions With Peripheral Globules: Proposal Of An Integrated Management Algorithm. Dermatol Pract Concept. 2023;13(1):e2023010. DOI: https://doi.org/10.5826/dpc.1301a10 Accepted: May 18, 2022; Published: January 2023 Copyright: ©2023 Cappilli 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: None. Authorship: All authors have contributed significantly to this publication. Corresponding author: Simone Cappilli, MD, Dermatologia, Dipartimento di Medicina e Chirurgia Traslazionale, Università Cattolica del Sacro Cuore, Rome, Italy. Largo A. Gemelli 8, 00168, Rome, Italy. Tel.: +39 06-30154227 Fax: +39 06-30154919 Email: simo.cappilli@gmail.com Citation: Cappilli S, Ribero S, Cornacchia L, et al. Melanocytic Lesions With Peripheral Globules: Proposal Of An Integrated Management Algorithm. Dermatol Pract Concept. 2023;13(1):e2023010. DOI: https://doi.org/10.5826/dpc.1301a10 Accepted: May 18, 2022; Published: January 2023 Copyright: ©2023 Cappilli 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: None. Authorship: All authors have contributed significantly to this publication. Corresponding author: Simone Cappilli, MD, Dermatologia, Dipartimento di Medicina e Chirurgia Traslazionale, Università Cattolica del Sacro Cuore, Rome, Italy. Largo A. Gemelli 8, 00168, Rome, Italy. Tel.: +39 06-30154227 Fax: +39 06-30154919 Email: simo.cappilli@gmail.com Introduction: A peripheral rim of globules represents a marker of horizontal growth phase in nevi and is a common feature in children and adolescents. The observation of melanocytic lesion with peripheral globules (MLPG) in adulthood deserve more attention, since a melanoma may exhibits this feature albeit rarely. Risk stratified management recommendations considering a global clinical approach are still missing. Objectives: To analyze current knowledge on MLPG and propose an integrated management algorithm stratified for age groups. Methods: We conducted a narrative review of current published data on MPLG, analyzing clinical dermoscopic and confocal distinguishing features of melanoma from bening nevi. Results: The risk of finding a melanoma when removing a MLPG increases with age especially in people >55 years old and results significantly higher on extremities, head/neck and in case of a single asymmetrical lesion, ≥6 mm in diameter. Dermoscopic features associated to melanoma diagnosis include atypical peripheral globules, asymmetrical distribution, multiple rims as well as globules reappearance after previous loss. In addition, wide blue-grey regression areas, atypical network, eccentric blotches, tan structureless peripheral areas and vascularizationare atypical dermoscopic features. Confocal worrisome findingss are represented by pagetoid cells within the epidermis, architectural disarrangement and atypical cells of the dermo-epidermal junction with irregular peripheral nests. Conclusion: We proposed a multi-step age-stratified management algorithm integrating clinical, dermoscopic and confocal findings that may increase the early recognition of melanoma and avoid surgical excision of benign nevi. Keywords : melanoma, reflectance confocal microscopy, diagnostic imaging, dermoscopy This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

Citation: Campana I, Cinotti E, Broganelli P, Di Stefani A, Trovato E, Provvidenziale L, Perotti R, Lamberti A, Rubegni P. Neurothekeomas: dermoscopic features of 3 cases. Dermatol Pract Concept. 2019;9(4):322-324. DOI: https://doi.org/10.5826/dpc.0904a21 Accepted: July 3, 2019; Published: October 31, 2019 Copyright: ©2019 Campana et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Funding: None. Competing interests: The authors have no conflicts of interest to disclose. Authorship: All authors have contributed significantly to this publication. Corresponding author: Irene Campana, MD, Department of Medical, Surgical and Neurological Science, Dermatology Section, University of Siena, S. Maria alle Scotte Hospital, Viale Bracci 16, 53100 Siena, Italy. Email: irenecamp89@gmail.com Keywords : neurothekeomas, dermoscopy, dermatopathology, skin tumors This work is licensed under a Creative Commons Attribution 4.0 International License.

“Harald Kittler” was not included as an author in the original publication