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The role of the optical super high magnification dermoscopy (O.S.H.M.D) in the management of melanocytic lesions

Dear Editor, The introduction of dermoscopy in the dermatological practice has improved the clinical recognition of various skin diseases, both of inflammatory and infectious nature. In addition, in the oncology field it facilitates the diagnosis of skin cancers. However, despite the progress in refining image acquisition and coding them through the search for patterns and criteria, in daily dermoscopic practice dermatologists often face cases of dubious interpretation. The use of new noninvasive in vivo diagnostic technologies such as confocal microscopy has implemented the clinical diagnostic potential of skin lesions. Optical super high magnification dermoscopy (O.S.H.M.D) represents a recent and innovative resource for noninvasive diagnostics. Using Fotofinder Medicam 1000 (Fotofinder System, Bad Birnbach, Germany), a pigmented lesion can be observed at up to 400 times the original magnification.1 It is possible to individually recognize the pigmented cells of the skin and the erythrocytes within the blood vessels of the papillae, with a real magnification close to the pathologist's histological section. The observation of thousands of images in OSHMD and the comparison with confocal microscopy and histology has allowed us to define a high magnification iconography useful for the search for patterns and diagnostic references of lesions in vivo,2– 4 although, also considering the immunohistochemical insights, the histopathology remains the gold standard in the diagnosis of melanocytic lesions.5– 7 We present the case of RR, a 20yearold male with a melanocytic lesion of the penis arisen about 4 years earlier. In anamnesis, he reported that the lesion increased in the first months of its appearance, but it stabilized in the last period, without further changes in size, shape or pigmentation. Clinically, the lesion appeared as a uniformly brown macule larger than 1 cm on the penile shaft and adjacent glans with jagged edges and an uneven pigment distribution (Figure 1). At the 20× dermoscopic examination, it was not possible to distinguish a welldefined dermoscopic pattern although a nesting structure at the shaft of the penis (Figure 1b) and a pattern of ‘brown dots’ in a nonchaotic arrangement at the level of the glans (Figure 1c) seem to prevail. Rather, less homogenous globules and nest structures appeared with more intensely pigmented regions. At the 400× examination, the high magnification allowed to identify circular melanocytes, regular and uniform in size, some more pigmented than others, which appear as small circles (Figure 2a,b). Some of these are distinguished by being small circles with a clear nonpigmented centre surrounded by a peripheral pigmented ring, while others are full, solid small circles with a uniformly pigmented centre and periphery. Both variants, ringappearance or solidappearance small circles, have the same size and shape. These elements are evenly distributed over the entire extent of the lesion on globular and nest architecture at the level of the shaft and on a carpet of brown dots on the mucosa of the glans. In contrast, the concomitant presence Received: 3 May 2022 | Accepted: 8 August 2022