Dermoscopy may be helpful as an adjuvant diagnostic tool for piloleiomyiomas (PL), according to research published in the Journal of the European Academy of Dermatology and Venereology. Dermoscopic studies associated with angioleiomyomas (AL) and leiomyosarcomas (LS) were more variable and less reliable.

Investigators obtained and evaluated digital dermoscopic images of 136 histopathologically confirmed cases of cutaneous smooth muscle neoplasms (PL, n=114; AL, n=13; LS, n=9) from 10 hospitals in Spain, Austria, and Italy. Data included age and sex of patients, anatomical location of the lesions, the presence of pain, and the clinical diagnosis or differential diagnoses before excision.

Upon dermoscopy, the histologic pattern of a symmetric, total delicate pigment network with the variable presence of multiple hypopigmented areas in a painful lesion most commonly associated with PL was found in 69.3% of PL cases (79 out of 114 lesions) and not observed in any cases of AL and LS. PL was painful in 78.1% of the cases. Patients with PL presented with a delicate pigment network located on the whole lesion. Symmetric, pink-reddish tumors with vascular and white structures were observed in 46.2% of AL, as well as in 3.5% of PL and in 22.2% of LS. Asymmetric, multilobulated tumor with linear-irregular or polymorphic-atypical vessels and white structures were found most commonly in LS (44.4%) and were associated with malignant tumors such as melanoma.

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Several limitations of this study exist. It was retrospective in nature, and the histopathologic diagnoses were unconfirmed by a second pathologist. Sensitivity and specificity of dermoscopic structure or pattern for the diagnosis of smooth muscle tumors were not analyzed.

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The authors concluded that dermoscopy can help in diagnosing AL and LS, but because they can simulate more serious lesions, they should continue to be studied histopathologically.

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Zaballos P, del Pozo LJ, Argenziano G, et al. Dermoscopy of cutaneous smooth muscle neoplasms: a morphological study of 136 cases [published online December 6, 2018]. J Eur Acad Dermatol Venereol. doi:10.1111/jdv.15392