Original article
Dermatoscopic vascular patterns in cutaneous Merkel cell carcinoma

https://doi.org/10.1016/j.jaad.2011.06.020Get rights and content

Background

Merkel cell carcinoma (MCC) is one of the most aggressive primary cutaneous malignancies. The clinical diagnosis of MCC is often delayed. Although the rarity of this skin cancer partially explains the low clinical suspicion by physicians, the absence of characteristic clinical features contributes to the delay in diagnosis. Dermatoscopy has proven a useful diagnostic tool in other cutaneous malignancies; however, the dermatoscopic features of cutaneous MCC are unknown.

Objective

We performed dermatoscopy on 10 primary cutaneous MCC to describe the dermatoscopic features and correlate these findings with the histopathologic parameters.

Methods

Consecutive patients with cutaneous MCC were identified and their tumors were evaluated under dermatoscopy. An 8-point MCC histopathology profile was recorded for each primary tumor in an attempt to correlate individual parameters with dermatoscopic features.

Results

All 10 tumors showed an irregular vascular pattern under dermatoscopy and demonstrated milky-red areas/globules and numerous linear irregular vessels. No correlation was noted between dermatoscopic and histopathologic features.

Limitations

The patients were from a single institution and tumors evaluated by a single dermatoscopic reviewer. Because of the rarity of this tumor, a small number of tumors were evaluated (10).

Conclusion

MCC exhibits a variety of dermatoscopic vascular patterns, most commonly milky-red areas/globules, polymorphous vessels, and linear-irregular vessels. Although we found no specific dermatoscopic pattern for MCC in our series, the polymorphous vascular pattern was atypical and suggestive of a malignant process. Further studies should be done to investigate the potential correlation between dermatoscopic features and histopathologic parameters.

Section snippets

Methods

Study approval was obtained from the Institutional Review Board of the University of Michigan Medical School. Consecutive patients were identified who presented to the Multidisciplinary Cutaneous Oncology Clinic at the University of Michigan Comprehensive Cancer Center from 2009 to 2010 with clinically present cutaneous MCC who were evaluated with dermatoscopy. All histopathology and immunohistochemical slides were reviewed and the diagnosis of MCC was confirmed by the University of Michigan

Results

A total of 10 MCC tumors in 10 patients were evaluated by dermatoscopy (Table I). Seven patients were female and 3 were male, ranging in age from 56 to 89 years; one patient was immunosuppressed. All 10 tumors were primary cutaneous lesions. Six (60%) tumors were located on the head and neck, with the remaining 4 (40%) on the extremities.

In 9 of the 10 tumors a complete MCC histopathology profile was available, whereas one tumor was unable to be fully evaluated because of crush artifact. Among

Discussion

In this series of 10 MCC tumors, we identified a number of dermatoscopic vascular patterns including milky-red areas and arborizing, linear-irregular, dotted, and glomerular vessels. Although none of the vascular patterns observed are specific for MCC, all indicate a malignant diagnosis and would prompt a biopsy to be performed.

Because MCC is often initially confused with a benign lesion, the average lesion is present for at least 5 months before a biopsy is performed.3 In at least 4 of our

References (14)

There are more references available in the full text version of this article.

Cited by (33)

  • Cells to Surgery Quiz: August 2019

    2019, Journal of Investigative Dermatology
  • Merkel Cell Carcinoma

    2017, Surgical Pathology Clinics
  • Clinical and dermoscopic features of combined cutaneous squamous cell carcinoma (SCC)/neuroendocrine [Merkel cell] carcinoma (MCC)

    2015, Journal of the American Academy of Dermatology
    Citation Excerpt :

    Dermoscopy may alert clinicians to biopsy presumed NMSC with atypical or polymorphous vascular patterns. Reported dermoscopic features of MCC include homogenous pink tumors with polymorphous vascular patterns.21-25 Milky-red areas/globules, polymorphous vessels, and linear-irregular vessels are the commonly identified vascular patterns.25

View all citing articles on Scopus

Funding sources: None.

Conflicts of interest: None declared.

View full text