P454ACCURACY OF INITIAL BIOPSY OF MELANOMA AND EFFECTS ON STAGING,TREATMENT & PROGNOSISChristopher W Kling, MD, St. Louis University, Manchester, MO, United States, ScottFosko, MD, St. Louis University, Manchester, MO, United States

How accurate is initial biopsy for melanoma? How often is a consultative reading orsurgical excision significantly different than initial biopsy? How does this difference inhistologic information affect staging/treatment/prognosis? Are there any establishedguidelines for dealing with differing histologic information for staging? These are some ofthe questions we attempt to answer through a retrospective review of the St. LouisUniversity (SLU) Melanoma Database from June 2001 thru May 2003. A total of 59 casesof primary cutaneous melanoma were reviewed retrospectively. Breslow’s depth (BD) oninitial biopsy report was compared with BD on consult report and WLE path report ifresidual tumor was seen for determination of accuracy. All cases in SLU MelanomaDatabase (n � 72) were reviewed. Patients with in-situ melanoma (n � 13) wereexcluded. Remaining patients with invasive melanoma (n � 59) were identified and theirrecords reviewed for initial biopsy type, initial BD, consult BD, WLE residual BD, andother clinical information including presence of ulceration & clinical stage according to2002 AJCC staging system. Accuracy was defined as Breslow’s depth in initial biopsygreater than or equal to that in 2nd biopsy or excision. Overall accuracy of initial biopsywas found to be 93% in this series.

Disclosure not available at press time.

P455A NEW BIDIMENSIONAL APPROACH FOR PIGMENTED SKIN LESIONS: HYPO-EPILUMINESCENCE MICROSCOPY.Domenico Piccolo, MD, Dept of Dermatology, University of L’Aquila, L’Aquila, Italy,Claudia Cotellessa, MD, Sergio Chimenti, MD, University of Tor Vergata, Rome, Italy,Ketty Peris, MD

Hypo-epiluminescence microscopy (HELM) is a new approach based on the doubleillumination of a lesion after surgical excision. The tecnique consists in positioninglesions on a glass slide and illuminating them with a led source underneath, and a digitalcamera with a special alogen lamp above. Thirty-one pigmented skin lesions wereanalyzed by epiluminescence microscopy (ELM) and HELM after surgical excision. Atypical ELM pigment network that appeared bidimensional with HELM was observed in11 of 31 lesions (35.5%). Nine of 31 lesions (29%) showed a central homogeneous darkbrown/black pigmentation by ELM. According to HELM examination, this pigmentationwas composed of globules in 7 of 9 cases (77.7%) histopathologically corresponding todermal nests of melanocytes. A network corresponding to pigmentation of the basal layerof the epidermis was seen by HELM in the remaining two cases (32.3%). ELM showed agray-blue pigmentation in 9 of 31 (29%) cases. In 5 of these 9 (55.5%) lesions, the HELMexamination showed a gray area, histopathologically related to regression (melanophagesin the upper dermis) and in 3 (33.3%) cases a blue area related to melanocytes in thedermis in the absence of regression. ELM showed a globular pattern in 2 of 31 (6.4%)lesions while HELM revealed the presence of a pigmented network combined withglobules in the same cases. Histopathologic examination indeed showed pigmentation ofthe epidermal basal layer and dermal nests of melanocytes. In one of 31 (3.2%) lesions, agray pigmentation (peppering) was detected by ELM whereas HELM showed a white areacombined with peppering, histopathologically corresponding to fibrosis and melanosis.Our results suggest that HELM may disclose features not visible by ELM and might behelpful to distinguish blue veil from regression structures.

Disclosure not available at press time.

P456LUPUS VULGARIS OF THE FACE ASSOCIATED WITH LENTIGO MALIGNAZulema Olazaran, MD, University Hospital U.A.N.L. Dr. Jose Eleuterio Gonzalez, Monter-rey, Mexico, Maira Herz, MD, University Hospital U.A.N.L. Dr. Jose Eleuterio Gonzalez,Monterrey, Mexico, Jorge Ocampo, MD, University Hospital U.A.N.L. Dr. Jose EleuterioGonzalez, Monterrey, Mexico, Oliverio Welsh, MD, PhD, University Hospital U.A.N.L. Dr.Jose Eleuterio Gonzalez, Monterrey, Mexico

Diverse chronic inflammatory and cicatricial lesions of the skin such as chronic ulcers,burn scars, discoid lupus erythematosus, hidradenitis suppurativa, dystrophic epidermol-ysis bullosa, and lupus vulgaris, have been associated to squamous cell carcinomas andless frequently to basal cell carcinomas.

We describe the case of a 70 year old female with a past history of lupus vulgaris affectingher right cheek and earlobe diagnosed in August 29th, 2001 and treated with isoniazid,rifampin, pyrazinamide, and ethambutol for one and a half years. Six months later duringher follow-up visit, a 2 � 2cms. irregular brownish plaque with several shades and arough surface was observed in the center of an erythematous violaceous plaque remain-ing from her previously treated lupus vulgaris. The lesion was biopsied in two differentsites, the first in the more pigmented area and the second in the light shade periphery ofthe lesion to discard a recurrence of the disease. The histological findings in one of thespecimens showed an atrophic epidermis containing an increased number of atypical andpleomorphic basal layer melanocytes conforming multiple nests along the epidermis. Inthe superior dermis a marked mononuclear cell lichenoid infiltrate and elastotic changesof the connective tissue were observed; the immunohistochemical staining was positivefor HMB-45. The second biopsy showed a lichenoid actinic keratosis with elastoticchanges.

The patient was treated with a complete surgical excision of the lesion with onecentimeter surgical margin.

The importance of this case is to report an uncommon association of Lupus Vulgaris andLentigo Maligna.

Disclosure not available at press time.

P457TANNING SALON MELANOMAThomas F. Downham II, MD, Henry Ford Health System, Taylor, MI, United States, AdrianOrmsby, MD, Henry Ford Health System, Taylor, MI, United States

There is more scientific and clinical evidence over the past several years that an increasedmelanoma risk exists from indoor UVA (320-400 nm) exposure from tanning sessionseither at home or in salons. Indoor UVA bulbs also emit approximately 5 to 10% UVB(280-320 nm) too. Both UVA and UVB have been implicated in the pathogenesis ofmelanoma.

Case Report: A 22 y/o red-haired, brown eyed female with Type II skin developed a leftupper arm nodular melanoma after six years of 20 minute daily tanning salon sessions. Shealso sunbathed in Michigan seasonal sunlight on clear sunny days for up to 60 minutes perday too. The nodular melanoma was 1.95-mm tumor thickness and Clark’s level III. Themitotic rate was high. There was no ulceration of the tumor. The regional lymph nodeswere not involved nor was there evidence of distant metastasis. All of the immunostainsfor melanoma were positive. Re-excision with a 2-cm margin was performed on theoriginal excision site.

Comment: Federal guidelines recommend no more than 150 tanning sessions per year.This patient had approximately 2100 sessions (350/year � 6) over a period of six years.In addition, the FDA guidelines recommend only 4 minimal erythemal doses (MEDs) persingle-session or a maximum of 12 MEDs per week of UVA radiation. Our patient had atotal of 2016 MEDs over a six-year period or more than 2.4 times the maximumrecommendation of the FDA. Thus, stricter Federal/FDA guidelines are needed regarding“daily tanning sessions” and in regards to maximum total dose/MEDs that the public maybe exposed to either at home or in tanning salons.

References:

1. Ultraviolet A and melanoma: a review. J Am Acad Dermatol. 2003 Mar; 48(3):464-5.

2. Risk of cutaneous malignant melanoma in relation to use of sunbeds: further evidencefor UVA carcinogenicity. Br J Cancer. 2000 May; 82(9):1593-9.

3. The Photobiology of UVA: Can It Lead to Melanoma? P551 AAD Poster Session, 61stAnnual Meeting, San Francisco, CA; March 21-26, 2003.

4. Increased Melanoma Risk from Indoor UVA Tanning. The Skin Cancer Foundation.www.skincancer.org/melanoma.tanning.php

Disclosure not available at press time.

P118 J AM ACAD DERMATOL MARCH 2004