Educational and practice gaps in the management of volar melanocytic lesions

Abstract

We found one major educational gap in the recognition of low-risk lesions with high rates of biopsy of the fibrillary pattern. Recognizing low-risk dermoscopic patterns could reduce the rate of biopsy of AMN by 23.3%. We identified two major practice gaps, poor patient compliance with follow-up and the potential insensitivity of the three-step algorithm to small multicomponent acral melanocytic lesions.

Acral lentiginous melanoma in situ: dermoscopic features and management strategy

“…However, the current literature on this topic is scarce. Data from Mayo clinic suggested that 6-mm acral melanomas could be missed when using the three-step algorithm 22 . Moreover, we reported two exceptional cases of evolving small ALMIS (4.5 mm and 5 mm).…”

Dermoscopy of melanoma according to different body sites: Head and neck, trunk, limbs, nail, mucosal and acral

“…The clinical three-step algorithm recommends a clinical cutoff for surgical excision when an acquired acral melanocytic lesion has a non-typical dermoscopic pattern, lesion diameter ≥7 mm and patient age >50 years, 87 The algorithm has sensitivity, specificity, PPV and NPV rates of 80%, 88%, 44% and 97%, respectively. 88 Notably, the low overall sensitivity may have been related to the relatively high frequency of small multicomponent AM diagnoses. Additionally, fibrillar pattern was commonly misclassified as a high-risk pattern by physicians.…”

“…Some dermoscopic algorithms and scores have been proposed to assist in both the differentiation of AM from benign lesions and early AM detection. The clinical three‐step algorithm recommends a clinical cutoff for surgical excision when an acquired acral melanocytic lesion has a non‐typical dermoscopic pattern, lesion diameter ≥7 mm and patient age >50 years, 87 The algorithm has sensitivity, specificity, PPV and NPV rates of 80%, 88%, 44% and 97%, respectively 88 . Notably, the low overall sensitivity may have been related to the relatively high frequency of small multicomponent AM diagnoses.…”

Dermoscopy for acral melanocytic lesions: Revision of the 3-step algorithm and refined definition of the regular and irregular fibrillar pattern

“…Based on these characteristic dermoscopic findings, in 2007 our group proposed a dermoscopic 3-step algorithm for the management of acral melanocytic lesions [3] and then, revised it in 2011 [4]. Recently, several studies were reported which examined utility of the 3-step algorithm [5][6][7]. In these studies, the 3-step algorithm generally worked well, however, in one study, the algorithm missed one lesion of AM, 0.5 mm in Breslow thickness.…”

“…One possible problem in using the 3-step algorithm is judgment of whether the FP is regular or irregular. According to Costello et al, physicians often did not recognize the regular FP as a benign pattern [6]. The FP is characterized by densely packed brownish fibrillar lines arranged in a parallel fashion and crossing the skin markings.…”