The "Umbrella Sign": A Useful Clue in the Diagnosis of Melanocytic Lesions in Sun Damaged Skin

The American Journal of Dermatopathology
Benjamin A Wood, Nathan T Harvey

Abstract

As ultraviolet radiation is an important aetiological agent in melanoma development, the presence of solar elastosis is an important factor in the assessment of any melanocytic lesion. However, melanocytic naevi are also seen in chronically sun damaged skin, particularly in regions with high levels of ultraviolet exposure and fair skinned populations. It has previously been noted that the relationship of a melanocytic proliferation to elastic fibers in the dermis can be of discriminatory value in the separation of melanoma from melanocytic naevus, in particular, it has been proposed that naevi act as a "sunscreen," which may result in a histological clue that the authors colloquially refer to in practice as "the umbrella sign." The aim of this study was to evaluate the patterns of solar elastosis within and beneath melanocytic proliferations developing in sun damaged skin and to determine the utility of the "umbrella sign" in diagnostic practice. We assessed 81 melanocytic proliferations in sun damaged skin for the presence of an umbrella sign, that was present in 49/53 melanocytic naevi (92%) compared with only 2/28 melanomas (7%, P < 0.05). In addition, entrapped elastotic fibers displaying distinct purple discolouration were...Continue Reading

References

Apr 24, 2007·Journal of Cutaneous Pathology·Marcelo G HorensteinTara N Evans
Sep 11, 2012·Journal of Cutaneous Pathology·Timothy H McCalmont
Jan 28, 2014·Annual Review of Pathology·Boris C Bastian
Apr 11, 2014·JAMA Dermatology·Fabrizio VairaStefano Veraldi
Jul 23, 2014·The American Journal of Dermatopathology·Michael SidiropoulosPedram Gerami

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Citations

Jul 31, 2018·Archives of Pathology & Laboratory Medicine·Nathan T Harvey, Benjamin A Wood
Dec 14, 2018·Archives of Dermatological Research·A StillhardHelmut Beltraminelli

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