The ABCD rule of dermatoscopy

Nachbar, F.; Stolz, Wilhelm; Merkle, Tanja; Cognetta, Armand B.; Vogt, Thomas; Landthaler, Míchael; Bilek, Peter; Braun‐Falco, Otto; Plewig, Gerd

doi:10.1016/s0190-9622(94)70061-3

Cited by 732 publications

(164 citation statements)

References 12 publications

(5 reference statements)

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“…); they have all been cooperating for several years within a research group working on the diagnosis of melanocytic skin neoplasms. As far as the diagnostic criteria were concerned, these eight observers were asked to refer for diagnosis to previously reported systematic methods (standard pattern analysis, 6,17,18 ABCD rule, 19,20 and seven point checklist 7 ). At the time of their examination, dermoscopists were unaware of the histopathologic diagnosis.…”

Section: Dermoscopymentioning

confidence: 99%

Dermoscopic and histopathologic diagnosis of equivocal melanocytic skin lesions

Ferrara

Argenziano

Soyer

et al. 2002

Cancer

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BACKGROUNDDermoscopy (dermatoscopy, epiluminescence microscopy) is increasingly employed for the preoperative detection of cutaneous melanoma; dermoscopic features of pigmented skin lesions have been previously defined using histopathology as the key to the code. In a preliminary study on 10 cases evaluated by nine dermoscopists and nine histopathologists, the authors experienced that when at least two dermoscopists disagree in evaluating a melanocytic lesion, even histopathologic consultations may give equivocal results.METHODSOne hundred seven melanocytic skin lesions, consecutively excised because of equivocal clinical and/or dermoscopic features, were retrospectively examined by eight dermoscopists and eight histopathologists; the diagnostic interobserver agreement was calculated by means of the Schouten k statistics. After histopathologic consultations, all 107 lesions underwent unblinded dermoscopic re‐evaluation in order to find which dermoscopic features had given rise to histopathologic diagnostic difficulties.RESULTSThe interobserver ageement was good for both dermoscopy (k = 0.53) and histopathology (k = 0.74). Out of 48 cases evaluated by the dermoscopists in complete accordance, only 8 (16.7%) received at least one conflicting histopathologic diagnosis. Instead, among the remaining 59 cases with at least one disagreeing dermoscopic diagnosis, 21 (35.6%) received at least one disagreeing histopathologic diagnosis. The unblinded dermoscopic re‐evaluation showed that five out of seven lesions with clear‐cut regression structures were histopathologically controversial.CONCLUSIONSAt least for selected and reasonably difficult lesions, a diagnostic discrepancy among formally trained dermoscopists seems to be predictive for a diagnostic disagreement among histopathologists. Lesions showing clear‐cut regression structures are prone to give some histopathologic disagreement. Cancer 2002;95:1094–1100. © 2002 American Cancer Society.DOI 10.1002/cncr.10768

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Section: Dermoscopymentioning

confidence: 99%

Dermoscopic and histopathologic diagnosis of equivocal melanocytic skin lesions

Ferrara

Argenziano

Soyer

et al. 2002

Cancer

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“…[11][12][13] In recent years, dermoscopy (ie, dermatoscopy, direct skin microscopy, epiluminescence microscopy, and surface microscopy) has become a routine clinical method for the more accurate diagnosis of melanocytic skin lesions. 14,15 Therefore, in this study, we investigated whether a single exposure of acquired melanocytic nevi to 2 minimal erythema doses (MEDs) results in changes detectable by dermoscopy.…”

mentioning

confidence: 99%

Ultraviolet Radiation of Melanocytic Nevi

Hofmann-Wellenhof

Soyer²,

Wolf³

et al. 1998

Arch Dermatol

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“…Dermatoscopy or epiluminescence microscopy has been introduced as an aid to clinical diagnosis and has been confirmed to be a useful technique also in our hands. The recent literature reports a range of 86–94% for sensitivity, and 79–81% for specificity [18, 19, 20, 21, 22]. It is widely accepted that it improves diagnostic accuracy, especially for small difficult-to-diagnose lesions [5, 6].…”

Section: Discussionmentioning

confidence: 99%

Melanoma Detection

Bono

Bartoli

Cascinelli³

et al. 2002

Dermatology

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Background: Successful treatment of melanoma depends directly on early diagnosis. Such a diagnosis is based on clinical examination and dermatoscopy. Recently, automated instruments for melanoma detection are under development. Objective: To prospectively evaluate the diagnostic possibilities provided by clinical and dermatoscopic examinations and by a computerized telespectrophotometric system (TS). Methods: The study involves a consecutive series of 298 patients with 313 cutaneous pigmented lesions (66 melanomas and 247 non-melanoma lesions). Each lesion was subjected to the triple diagnostic evaluation, before surgery. Results were expressed in terms of sensitivity and specificity of each kind of evaluation. Results: Clinical evaluation had sensitivity and specificity values of 86 and 77%, respectively, whereas dermatoscopy gave corresponding values of 91 and 74%. TS assessment resulted in a sensitivity of 80% and a specificity of 49%. Differences between clinical and dermatoscopic diagnoses lacked statistical significance (p = 0.22), whereas there was a significant difference comparing both clinical and TS evaluations (p < 0.01) and dermatoscopic and TS evaluations (p < 0.01). Combining clinical and dermatoscopic evaluations, a sensitivity of 97% was achieved. Addition of TS has not changed this figure. Conclusions: Results of this study confirm and stress the importance of dermatoscopy in the diagnosis of melanoma. Clinical evaluation coupled with dermatoscopy can be considered the cornerstone of such a diagnosis. Although TS is able to achieve interesting results, at present it cannot significantly compete with any of the other tested methods.

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The ABCD rule of dermatoscopy

Abstract: The ABCD rule can be easily learned and rapidly calculated, and has proven to be reliable. It should be routinely applied to all equivocal pigmented skin lesions to reach a more objective and reproducible diagnosis and to obtain this assessment preoperatively.

Cited by 732 publications

References 12 publications

Dermoscopic and histopathologic diagnosis of equivocal melanocytic skin lesions

Dermoscopic and histopathologic diagnosis of equivocal melanocytic skin lesions

Ultraviolet Radiation of Melanocytic Nevi

Melanoma Detection

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