Accuracy of Dermoscopic Criteria for the Diagnosis of Melanoma In Situ

Abstract

The accuracy of melanoma-specific dermoscopic criteria has been tested mainly in studies including invasive tumors. Scarce evidence exists on the usefulness of these criteria for the diagnosis of melanoma in situ (MIS). OBJECTIVE To investigate the diagnostic accuracy of dermoscopic criteria for the diagnosis of MIS. DESIGN, SETTING, AND PARTICIPANTS A diagnostic accuracy study with retrospective patient enrollment was conducted in 3 centers specializing in skin cancer diagnosis and management. A total of 1285 individuals with histopathologically diagnosed MIS or other flat, pigmented skin tumors that were histopathologically diagnosed or monitored for at least 1 year were included. Dermoscopic images of MIS and other flat, pigmented skin tumors were evaluated by 3 independent investigators for the presence of predefined criteria. Evaluators were blinded to the clinic dermoscopic and histopathologic diagnosis. MAIN OUTCOMES AND MEASURES Frequencies of dermoscopic criteria per diagnosis were calculated. Crude odds ratios, adjusted odds ratios, and corresponding 95% CIs were calculated by univariate and multivariate logistic regression, respectively. RESULTS A total of 1285 patients were included in the study (642 [50%] male); mean age was 45.9 years (range, 9-91 years). Of a total of 1285 lesions obtained from these patients, 325 (25.3%) were MIS; 574 (44.7%) were nevi (312 [24.3%] excised and 262 [20.4%] not excised); 67 (5.2%) were seborrheic keratoses, solar lentigines, or lichen planus-like keratoses; 91 (7.1%) were pigmented superficial basal cell carcinomas; 26 (2.0%) were pigmented intraepithelial carcinomas; 100 (7.8%) were Reed nevi; and 102 (7.9%) were invasive melanomas with a Breslow thickness less than 0.75 mm. The most frequent dermoscopic criteria for MIS were regression (302 [92.9%]), atypical network (278 [85.5%]), and irregular dots and/or globules (163 [50.2%]). The multivariate analysis revealed 5 main positive dermoscopic indicators of MIS: atypical network (3.7-fold; 95% CI, 2.5-5.4), regression (4.7-fold; 95% CI, 2.8-8.1), irregular hyperpigmented areas (5.4-fold; 95% CI, 3.7-8.0), prominent skin markings (3.4-fold; 95% CI, 1.9-6.1), and angulated lines (2.2-fold; 95% CI, 1.2-4.1). When compared only with excised nevi, 2 of these criteria remained potent MIS indicators, namely, irregular hyperpigmented areas (4.3-fold; 95% CI, 2.7-6.8) and prominent skin markings (2.7-fold; 95% CI, 1.3-5.7). CONCLUSIONS AND RELEVANCE Clinicians should take into consideration the aforementioned dermoscopic indicators for the diagnosis of MIS.

Neck Melanoma: Clinical, Dermoscopic and Confocal Features

“…Interestingly, the current study demonstrated that the presence of irregular hyperpigmented areas and irregular blotches was found to be significantly related to melano-ma diagnosis: irregular hyperpigmented areas are confirmed to be a very potent dermoscopic descriptor for in situ or thin melanoma [4].…”

Validation of an integrated dermoscopic scoring method in an European teledermoscopy web platform: the iDScore project for early detection of melanoma

“…Thus, comparison of diagnostic accuracy in the four different tests was not constructed artificially through participants' consensus evaluation of individual criteria. 12 In addition, time for evaluation was defined but not unlimited, as in other studies, [15][16][17][18][19] reproducing a certain minimal stress level as in clinical activity. As recently demonstrated in a Cochrane review, the accuracy of teledermoscopic diagnosis, as well as the concordance between teledermoscopic (store-and-forward) diagnosis and face-to-face diagnosis, depend on an adequate preselection of cases.…”

Histogenesis of cutaneous malignant melanoma: The vast majority do not develop from melanocytic nevus but arise de novo as melanoma in situ

“…Lallas et al . have found that two new dermoscopic findings, irregular hyperpigmented areas and prominent skin markings, are significantly characteristic of SSM in situ , which could help us in dermoscopically differentiating SSM in situ from atypical nevus . However, even in their study, SSM in situ and atypical nevus were mostly the same in the prevalence of the dermoscopic global patterns and local features.…”