Amelanotic melanoma and pyogenic granuloma. Peculiarities of the differential diagnosis

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Abstract

INTRODUCTION: Nodular melanoma is a rapidly progressive skin tumour with a high risk of methastasis even on early stages. This fact leads to necessity of non-invasive procedures, which can verify this diagnosis before surgery. Nodular forms of amelanotic melanoma can be hardly diagnosed because of their unusual diagnostic and dermatoscopic features.

CASE REPORT: Pyogenic granuloma is the most difficult disease for differential diagnosis. It is a benign vascular formation, which mimics nodular amelanotic melanoma.

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About the authors

Azizzhon D. Zikiryachodzhaev

P.A. Hertsen Moscow Oncology Research Center, Moscow, Russian Federation

Email: ivertieva@gmail.com
ORCID iD: 0000-0001-7141-2502
Russian Federation, Moscow

E. K. Saribekyan

P.A. Hertsen Moscow Oncology Research Center, Moscow, Russian Federation

Email: ivertieva@gmail.com
ORCID iD: 0000-0002-1559-1304
Russian Federation, Moscow

E. Yu. Vertieva

I.M. Sechenov First Moscow State Medical University (Sechenov University)

Author for correspondence.
Email: ivertieva@gmail.com
ORCID iD: 0000-0002-1088-2911

MD, PhD

Russian Federation, Moscow

I. S. Pestin

P.A. Hertsen Moscow Oncology Research Center, Moscow, Russian Federation

Email: ivertieva@gmail.com
Russian Federation, Moscow

References

  1. Guggenheim M, Hug U, Jung F, Rousson V, Aust M, Calcagni M, et al. Morbidity and recurrence after completion lymph node dissection following sentinel lymph node biopsy in cutaneous malignant melanoma. Ann Surg. 2008;247(4):687-93. doi: 10.1097/SLA.0b013e318161312a
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  3. Yoradjian A, Azevedo M, Cattini L, Basso R. Pyogenic granuloma: Description of two unusual cases and review of the literature. Surg Cosmetic Dermatol. 2013;5(3):263-8.
  4. Lin R, Janniger C. Pyogenic granuloma. Cutis. 2004;74(4):229-33.
  5. Zaballos P, Carulla M, Ozdemir F, Zalaudek I, Bañuls J, Llambrich A, et al. Dermoscopy of pyogenic granuloma: a morphological study. Br J Dermatol. 2010;163(6):1229-37. doi: 10.1111/j.1365-2133.2010.10040.x
  6. Lacarrubba F, Caltabiano R, Micali G. Dermoscopic and histological correlation of an atypical case of pyogenic granuloma. Pediatr Dermatol. 2013;30(4):499-501. doi: 10.1111/pde.12123
  7. Papageorgiou C, Ioannides D, Apalla Z. Dermoscopy of difficult-to-diagnose Melanomas. Serbian J Dermatol Venereol. 2016;8(3):121-7.
  8. Togawa Y. Dermoscopy for the diagnosis of melanoma: an overview. Austin J Dermatol. 2017;4(3):1080.

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2. Fig. 1. Patient M., 58 years old. Pyogenic granuloma. a - macroscopic picture; a node of bright red color, soft consistency, there is a hemorrhagic discharge on the surface; b - dermatoscopic picture: red homogeneous zones, weakly expressed white bridges, blue homogeneous pigmentation along the periphery.

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3. Fig. 2. Histological specimen. A tumor with an ulcerated skin surface (blue arrow), multilobular vascular structures (green arrow). Staining with hematoxylin and eosin. x 100.

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4. Fig. 3. Histological specimen. The tumor is represented by full-blooded capillaries (blue arrow). There is a pronounced mixed cell inflammation in the stroma (green arrow). Staining with hematoxylin and eosin. x 200.

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5. Fig. 4. 4. Patient L., 32 years old. Pyogenic granuloma during pregnancy, 34 weeks. a - pink knot with hemorrhagic crust on the surface; b - dermatoscopic picture: milky-red globular zones, white bridges, ulceration zone.

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6. Fig. 5. Histological specimen. Tumor with adjacent tissues. Hyperplasia of the epithelium over the tumor. Expanded full-blooded tumor capillaries. Staining with hematoxylin and eosin. x 50.

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7. Fig. 6. Patient Sh., 78 years old. Nodular non-pigmented melanoma of the skin of the left cheek. a - a knot of dense consistency with an erosive surface; b - dermatoscopy of non-pigmented melanoma: polymorphic atypical vessels.

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