Differentiation of combined nevi and melanomas: Case‐control study with comparative analysis of dermoscopic features

Schweizer, Anissa; Fink, Christine; Bertlich, Ines; Toberer, Ferdinand; Mitteldorf, Christina; Stolz, Wilhelm; Enk, Alexander; Kilian, Samuel; Haenssle, Holger A.

doi:10.1111/ddg.14019

Cited by 17 publications

(19 citation statements)

References 22 publications

(52 reference statements)

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“…Because we had incomplete information on whether dermatoscopy images were taken in polarized or non‐polarized mode, we could not further analyse this potentially confounding factor. Our observations are in line with smaller case series 3,6,16,17 and with the results of a recent study by Schweizer et al ., 10 in which the authors reported a relatively low frequency of melanoma clues in CBN.…”

Section: Discussionsupporting

confidence: 93%

“…Here, we demonstrate that this structureless blue area of CBN is typically well defined and often, albeit not always, located in the centre of the lesion. In these typical cases, the overall presentation of the CBN will be symmetrical with regard to colour and structure and not chaotic 10,16 . This presentation is also known as the targetoid combined blue naevus type 16 .…”

Section: Discussionmentioning

confidence: 96%

“…The current literature of the dermatoscopy of CBN is limited to case reports or small case series 3–9 . Schweizer et al 10 . recently published the largest cases series including 36 CBN from various centres.…”

Section: Introductionmentioning

confidence: 99%

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Dermatoscopy of combined blue nevi: a multicentre study of the International Dermoscopy Society

Stojkovic-Filipovic

Tiodorović

Lallas

et al. 2021

Acad Dermatol Venereol

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Background Combined blue nevi (CBN) may mimic melanoma and are relatively often biopsied for diagnostic reasons. Objective To better characterize CBN and to compare it with melanoma. Methods We collected clinical and dermatoscopic images of 111 histologically confirmed CBN and contrasted their dermatoscopic characteristics with 132 partly blue coloured melanomas. Furthermore, we compared the accuracy of human experts using pattern analysis with a computer algorithm based on deep learning. Results Combined blue nevi are usually flat or slightly elevated and, in comparison with melanoma, more frequent on the head and neck. Dermatoscopically, they are typified by a blue structureless part in combination with either brown clods (n = 52, 46.8%), lines (n = 28, 25.2%) or skin‐coloured or brown structureless areas (n = 31, 27.9%). In contrast with melanoma, the blue part of CBN is more often well defined (18.9% vs. 4.5%, P < 0.001) and more often located in the centre (22.5% vs. 5.3%, P < 0.001). Melanomas are more often chaotic (OR: 28.7, 95% CI: 14.8–55.7, P < 0.001), have at least one melanoma clue (OR: 10.8, 95% CI: 5.2–22.2 P < 0.001) in particular white lines (OR: 37.1, 95% CI: 13.4–102.9, P < 0.001). Using simplified pattern analysis (chaos and clues), two raters reached sensitivities of 93.9% (95% CI: 88.4–97.3%) and 92.4% (95% CI: 86.5–96.3%) at corresponding specificities of 59.5% (95% CI: 49.7–68.7%) and 65.8% (95% CI: 56.2–74.5%). The human accuracy with pattern analysis was on par with a state‐of‐the‐art computer algorithm based on deep learning that achieved an area under the curve of (0.92, 95% CI: 0.87–0.96) and a specificity of 85.3% (95% CI: 76.5–91.7%) at a given sensitivity of 83.6% (95% CI: 72.5–91.5%). Conclusion CBN usually lack melanoma clues, in particular white lines. The accuracy of pattern analysis for combined nevi is acceptable, and histopathologic confirmation may not be necessary in exemplary cases.

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Section: Discussionsupporting

confidence: 93%

Section: Discussionmentioning

confidence: 96%

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Dermatoscopy of combined blue nevi: a multicentre study of the International Dermoscopy Society

Stojkovic-Filipovic

Tiodorović

Lallas

et al. 2021

Acad Dermatol Venereol

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“…Reed nevus, cellular blue nevus, deep penetrating nevus, and combined nevus are examples of truly benign lesions that nevertheless bear strong resemblance to melanoma, histologically as well, and may therefore result in overdiagnosis [36]. Even though the features expected to be exclusive to melanomas or nevi are described in increasingly specific terms, thus improving the correct clinical diagnosis [37], differentiation in these cases remains challenging.…”

Section: Underdiagnosis and Overdiagnosismentioning

confidence: 99%

Overdiagnosis of melanoma – causes, consequences and solutions

Kutzner

Jutzi

Krahl³

et al. 2020

J Deutsche Derma Gesell

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Summary Malignant melanoma is the skin tumor that causes most deaths in Germany. At an early stage, melanoma is well treatable, so early detection is essential. However, the skin cancer screening program in Germany has been criticized because although melanomas have been diagnosed more frequently since introduction of the program, the mortality from malignant melanoma has not decreased. This indicates that the observed increase in melanoma diagnoses be due to overdiagnosis, i.e. to the detection of lesions that would never have created serious health problems for the patients. One of the reasons is the challenging distinction between some benign and malignant lesions. In addition, there may be lesions that are biologically equivocal, and other lesions that are classified as malignant according to current criteria, but that grow so slowly that they would never have posed a threat to patient’s life. So far, these “indolent” melanomas cannot be identified reliably due to a lack of biomarkers. Moreover, the likelihood that an in‐situ melanoma will progress to an invasive tumor still cannot be determined with any certainty. When benign lesions are diagnosed as melanoma, the consequences are unnecessary psychological and physical stress for the affected patients and incurred therapy costs. Vice versa, underdiagnoses in the sense of overlooked melanomas can adversely affect patients’ prognoses and may necessitate more intense therapies. Novel diagnostic options could reduce the number of over‐ and underdiagnoses and contribute to more objective diagnoses in borderline cases. One strategy that has yielded promising results in pilot studies is the use of artificial intelligence‐based diagnostic tools. However, these applications still await translation into clinical and pathological routine.

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“…Beispiele für eindeutig gutartige Läsionen, die aber selbst auf feingeweblicher Ebene Melanomen sehr stark ähneln und so zu Überdiagnosen führen können, sind der Reed Nävus, der zelluläre blaue Nävus, der deep penetrating nevus oder der kombinierte Nävus [36]. Auch wenn die Merkmale, die ausschließlich bei Melanomen oder bei Nävi zu erwarten sind, immer differenzierter beschrieben werden und die korrekte klinische Diagnose verbessern [37], bleibt die Unterscheidung in diesen Fällen schwierig.…”

Section: Unterdiagnosen Und üBerdiagnosenunclassified

Überdiagnose von Melanomen – Ursachen, Konsequenzen und Lösungsansätze

Kutzner

Jutzi

Krahl³

et al. 2020

J Deutsche Derma Gesell

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Zusammenfassung Das maligne Melanom ist diejenige Form von Hautkrebs, an der die meisten Menschen sterben. Im Frühstadium ist das Melanom gut behandelbar, eine Früherkennung ist also lebenswichtig. Kritiker bemängeln, dass seit der bundesweiten Einführung des Hautkrebs‐Screenings häufiger Melanome diagnostiziert werden, die Sterblichkeit am malignen Melanom jedoch nicht zurückgegangen ist. Sie führen dies vor allem auf Überdiagnosen zurück. Ein Grund ist die zum Teil komplexe Unterscheidung zwischen benignen und malignen Läsionen. Hinzu kommt, dass es auch Übergangsformen zwischen eindeutig gut‐ oder bösartigen Läsionen geben kann, und dass einige bösartige Läsionen so wenig aggressiv wachsen, dass sie nie lebensbedrohlich geworden wären. Bisher kann mangels entsprechender Biomarker nicht festgestellt werden, bei welchen Melanomen dies der Fall ist. Auch die Progressionswahrscheinlichkeit eines In‐situ‐Melanoms zu einem invasiven Tumor kann bisher nicht sicher beurteilt werden. Die Konsequenzen für überdiagnostizierte benigne Läsionen sind unnötige psychische und körperliche Belastungen für die Betroffenen und anfallende Therapiekosten. Umgekehrt können Unterdiagnosen zu gravierenden Einschränkungen der Prognose der Betroffenen und zur Notwendigkeit belastender(er) Therapien führen. Präzisere Diagnosemöglichkeiten könnten die Anzahl der korrekten Diagnosen erhöhen. Hier haben sich in Studien mit auf künstlicher Intelligenz basierenden Assistenzsystemen bereits erste Erfolge gezeigt, die allerdings noch in die klinische und pathologische Routine übertragen werden müssen.

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Differentiation of combined nevi and melanomas: Case‐control study with comparative analysis of dermoscopic features

Cited by 17 publications

References 22 publications

Dermatoscopy of combined blue nevi: a multicentre study of the International Dermoscopy Society

Dermatoscopy of combined blue nevi: a multicentre study of the International Dermoscopy Society

Overdiagnosis of melanoma – causes, consequences and solutions

Überdiagnose von Melanomen – Ursachen, Konsequenzen und Lösungsansätze

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