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. 2012 Mar;66(3):452-62.
doi: 10.1016/j.jaad.2011.02.033. Epub 2011 Jul 28.

Langerhans cells and melanocytes share similar morphologic features under in vivo reflectance confocal microscopy: a challenge for melanoma diagnosis

Pantea Hashemi  1 , Melissa P Pulitzer, Alon Scope, Ivanka Kovalyshyn, Allan C Halpern, Ashfaq A Marghoob
Affiliations

Langerhans cells and melanocytes share similar morphologic features under in vivo reflectance confocal microscopy: a challenge for melanoma diagnosis

Pantea Hashemi et al. J Am Acad Dermatol. 2012 Mar.

Abstract

Background: Intraepidermal Langerhans cells (ILC) are difficult to differentiate from melanocytes under reflectance confocal microscopy (RCM) and their presence may simulate pagetoid spread of melanocytes on RCM images.

Objective: We sought to correlate bright round and dendritic cells in a pagetoid pattern identified on RCM with findings of conventional histopathology and immunohistochemistry for lesions that were falsely diagnosed as melanoma by RCM.

Methods: This retrospective study included histopathologically proven nevi, imaged by RCM, which displayed bright cells in a pagetoid pattern (BCPP) under RCM, resulting in the incorrect RCM diagnosis of melanoma. Morphological comparisons were made between RCM images of nevi showing BCPP, histopathologically proven melanomas displaying BCPP, and biopsy-proven nevi without BCPP.

Results: We identified 24 nevi that were falsely diagnosed as melanoma by RCM because of the presence of BCPP. These pagetoid cells on RCM corresponded on histopathology to ILC with a high density in 23 of the 24 nevi (95%) and to melanocytes in 7 of the 24 nevi (29%). Among 6 melanomas displaying BCPP on RCM, ILC with high density were observed histopathologically in 5 of the 6 cases (83%) and pagetoid melanocytes were seen in all 6 cases (100%).

Limitations: The results cannot be generalized to clinically banal-appearing nevi.

Conclusions: Although the finding of BCPP is a useful RCM feature for the diagnosis of melanoma, it does not always imply the presence of pagetoid melanocytes but may at times represent ILC.

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Conflict of interest statement

Conflict of interest: The original grant was obtained by Lucid Inc., Rochester, New York for the study of “In-vivo Confocal Reflectance Microscopy for Pigmented Lesion Diagnosis”. Technical equipment from Lucid Inc. was employed for this study. No known financial conflicts of interests exist.

Figures

Case 1
Case 1
A. Dermoscopic image of an asymmetric pigmented lesion (group A) on the lower back of a 57-year man reveals biaxial asymmetry of colors and structures and a multi-component global pattern with foci showing negative network, blue–white structures, and peripheral structureless areas. Clinically and dermoscopically, the lesion was suspicious for melanoma. B. RCM basic image (0.5mm × 0.5mm) at the level of spinous layer shows small bright dendritic cells and dendritic processes (→) in medium density. C. Histopathologic analysis (H&E; original magnification ×200) shows a compound dysplastic nevus; the proliferation of melanocytes at the dermo-epidermal junction is mostly nested, cells in pagetoid pattern are not seen, and all of the melanocytes have small, oval nuclei. D. Immunohistochemistry for Melan-A displayes a few melanocytes in the basal layer.
Case 2
Case 2
A. Dermoscopic image of a brown lesion (group A) on the abdomen of 61-year-old male shows an ill-demarcated lesion with a patchy network and an eccentric, peripheral black blotch. B. Basic RCM image (0.5mm × 0.5 mm) at the level of the spinous layer, from the dermoscopically-identified eccentric blotch, demonstrates a cobblestone pattern (→) in which few small, bright pleomorphic cells (❍) are seen in pagetoid pattern. C. Histopathologic analysis (H&E; original magnification ×50) shows a compound melanocytic nevus. There is mostly-lentiginous proliferation of melanocytes along the dermo-epidermal junction, but melanocytes in pagetoid pattern are not seen. D. Immunohistochemistry for CD1a reveals scattered intraepidermal Langerhans cells.
Case 3
Case 3
A. Dermoscopic image of a 7-mm brown-black lesion (group A) on the abdomen of a 60 year-old male shows a multi-component pattern with peripheral network and central blue-white structures. The lesion was clinically and dermoscopically suspicious for melanoma. B. Basic RCM image (0.5mm × 0.5mm) at the dermo-epidermal junction and basal layer displays a disarranged pattern with bright dendritic and roundish nucleated cells (→) in medium density. C.: Histopathologic analysis (H&E; original magnification ×100) reveals a compound nevus, characterized by a proliferation of melanocytes as solitary units or small and large nests situated at the dermoepidermal junction and in the papillary dermis. The melanocytes have small oval monomorphous nuclei and scant cytoplasm. D. Staining for Melan-A reveals numerous melanocytes in the basal and spinous layers.
Case 4
Case 4
A: Dermoscopic image of a 5-mm brown lesion (group A) on the shoulder of a 45-year-old male reveals a patchy reticulated network with focal loss of network at one pole. B. Basic RCM image (0.5mm × 0.5 mm) at the level of the spinous layer displays an irregular cobblestone pattern with few small roundish and gamma-shaped bright cells (→) in pagetoid pattern. C. Histopathologic analysis (H&E; original magnification × 100) reveals a compound nevus with proliferation of monomorphous melanocytes in regular nests at the dermo-epidermal junction, and in the papillary dermis, and reticular dermis. D. CD1a staining reveals scattered Langerhans cells in the spinous layer.
Case 5
Case 5
A. Dermoscopic image of a 3×6 mm irregular, brown macule (group C) on the cheek of a 72-year-old male displays a multi-component pattern with an atypical network and blue-white structures. B. Basic RCM image (0.5mm × 0.5mm) at the spinous layer shows a disarranged pattern with numerous large, bright dendritic cells (→) in a pagetoid pattern. C. Histopathologic analysis (H&E; original magnification ×50) reveals a dense proliferation of melanocytes as solitary units and irregular nests at the dermo-epidermal junction and extending down adnexal structures. Solitary melanocytes in pagetoid pattern (❍) are seen. The final diagnosis was melanoma, superficial Clark level IV. D. Immunohistochemistry for CD1a reveals a few intraepidermal Langerhans cells.
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References

    1. Rajadhyaksha M, Grossman M, Esterowitz D, Webb RH, Anderson RR. In vivo confocal scanning laser microscopy of human skin: melanin provides strong contrast. J Invest Dermatol. 1995 Jun;104(6):946–952. - PubMed
    1. Yamashita T, Kuwahara T, Gonzalez S, Takahashi M. Non-invasive visualization of melanin and melanocytes by reflectance-mode confocal microscopy. J Invest Dermatol. 2005 Jan;124(1):235–240. - PubMed
    1. Gerger A, Koller S, Kern T, et al. Diagnostic applicability of in vivo confocal laser scanning microscopy in melanocytic skin tumors. J Invest Dermatol. 2005 Mar;124(3):493–498. - PubMed
    1. Pellacani G, Cesinaro AM, Longo C, Grana C, Seidenari S. Microscopic in vivo description of cellular architecture of dermoscopic pigment network in nevi and melanomas. Arch Dermatol. 2005 Feb;141(2):147–154. - PubMed
    1. Curiel-Lewandrowski C, Williams CM, Swindells KJ, et al. Use of in vivo confocal microscopy in malignant melanoma: an aid in diagnosis and assessment of surgical and nonsurgical therapeutic approaches. Arch Dermatol. 2004 Sep;140(9):1127–1132. - PubMed

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