Diagnostic accuracy of dermatoscopy for melanocytic and nonmelanocytic pigmented lesions

School of Medicine, University of Queensland, Brisbane, Australia.
Journal of the American Academy of Dermatology (Impact Factor: 4.45). 03/2011; 64(6):1068-73. DOI: 10.1016/j.jaad.2010.03.039
Source: PubMed


It is unknown whether dermatoscopy improves the diagnostic accuracy for all types of pigmented skin lesions or only for those that are melanocytic.
We sought to assess if the addition of dermatoscopy to clinical examination with the unaided eye improves diagnostic accuracy for all types of pigmented lesions.
We analyzed 463 consecutively excised pigmented skin lesions collected during a period of 30 months in a primary care skin cancer practice in Queensland, Australia.
Of 463 lesions, 217 (46.9%) were nonmelanocytic. Overall 30% (n = 138) were malignant including 29 melanomas, 72 basal cell carcinomas, and 37 squamous cell carcinomas. The diagnostic accuracy for malignant neoplasms measured as area under receiver operating characteristic curves was 0.89 with dermatoscopy and 0.83 without it (P < .001). Given a fixed specificity of 80%, the corresponding sensitivity was 82.6% with dermatoscopy and 70.5% without it. The improvement achieved by dermatoscopy was higher for nonmelanocytic lesions than for melanocytic lesions. A short algorithm based on pattern analysis reached a sensitivity of 98.6% for basal cell carcinoma, 86.5% for pigmented squamous cell carcinoma, and 79.3% for melanoma. Among benign conditions, the highest false-positive rate (90.5%) was observed for lichen planus-like keratosis.
Estimates of diagnostic accuracy are influenced by verification bias.
Dermatoscopy improves the diagnostic accuracy for nonmelanocytic lesions. A simple algorithm based on pattern analysis is suitable for the detection of melanoma and nonmelanoma skin cancer.

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Available from: Harald Kittler, Dec 28, 2013
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    • "In addition to these pigment clues, there were vascular dermatoscopic clues including an eccentric structurless pink area (Figure 2 upper pole) and a random arrangement of polymorphous vessels. Both milky red pink areas and linear irregular vessels are described as clues to AHM by Menzies et al. [7], and an eccentric structureless area (any color except skin color, including pink) and polymorphous vessels have been evaluated as clues to malignancy in RPA [8]. "
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    ABSTRACT: A case of a predominantly yellow primary superficial spreading melanoma arising on the back of a 44-year-old woman is presented. Possible causes of the clinical and dermatoscopic yellow color are discussed. Staining with the histochemical stain, Sudan Black, revealed a differential uptake compared to a closely matched control melanoma. We speculate that the clinical and dermatoscopic yellow color could be due to the presence of increased amounts of the pigment lipofuscin, which is known to produce subtle orange color in some choroidal melanomas.
    04/2014; 4(2):45-9. DOI:10.5826/dpc.0402a09
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    • "Likewise this lesion did not score as a melanoma according to the ABCD dermatoscopic algorithm [9], the 3-point checklist [10], the 7-point checklist [11], the Menzies method [12] or the CASH algorithm [13]. The “Chaos & Clues” algorithm [14,15] identifies suspicion for malignancy based on the presence of chaos (defined as asymmetry of structure and/or color) plus the presence of at least one of eight clues, including the clue of “white lines,” and therefore that method would identify this lesion as suspicious but only if polarized dermatoscopy was employed. "
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    ABSTRACT: We report a case of a melanoma arising in a congenital-type compound nevus, which was excised because it was observed by both the patient and the treating dermatologist to have changed. Because the lesion was routinely photo-documented with both polarized and non-polarized dermatoscopy images prior to excision, these images were available for subsequent examination. Matched images are presented in what appears to be unique in the published literature: polarizing-specific white lines are identified as a compelling clue to the diagnosis of melanoma in a lesion that contains no clues apparent in the non-polarized image. Dermatopathology images reveal that the melanoma is arising in conjunction with a congenital type nevus. As expected, dermatoscopic polarizing-specific white lines are evident on the melanoma but not the nevus, and while a possible explanation is discussed, this remains speculative.
    01/2014; 4(1):83-7. DOI:10.5826/dpc.0401a14
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    • "While limited material has been published for stepwise dermatoscopic assessment of non-pigmented skin lesions [1,2], dermatoscopy has mainly been proposed as an aid to the diagnosis of pigmented skin lesions, and it has been shown to increase diagnostic accuracy for all pigmented lesions, melanocytic and non-melanocytic [3–5]. Pattern analysis was the original method of description and diagnosis for pigmented lesions [6] and, despite the development of many “simplified” algorithms, remains the method of experts. "
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    ABSTRACT: While there are several published comprehensive stepwise algorithmic methods for diagnosing pigmented skin malignancy, only limited material has been published for the stepwise assessment of non-pigmented lesions. We present a method based on pattern analysis, with a stepwise assessment, first, for ulceration, second, for white clues (defined as white lines, or in the case of a raised lesion any of the keratin clues: dermatoscopic white circles, dermatoscopic white structureless areas or surface keratin), and third, if no ulceration or white clues are present, proceed to vessel pattern analysis. This is a novel method, and apart from the assessment of white clues in raised lesions, it has not been formally tested. The priority of keratin clues in raised lesions over vessel pattern analysis has, however, been verified. It is conceded that this method is less specific than methods which have clues of pigmented structures, and accepting these limitations, Prediction without Pigment is a decision algorithm intended to guide the clinician in the decision as to whether to perform a biopsy rather than consistently leading to a specific diagnosis. Reaching a more specific diagnosis at the end of our flowchart can be achieved by weighing of clues both clinical and dermatoscopic, and that ability can be expected to improve with both knowledge and experience, but no diagnostic method, including this one, can be 100% sensitive in diagnosing malignancy, in particular, melanoma. Taking these limitations into account, any non-pigmented lesion, regardless of pattern analysis, which is raised and firm (nodular) and for which a confident, specific benign diagnosis cannot be made, should be excised to exclude the nodular variant of amelanotic melanoma.
    01/2014; 4(1):59-66. DOI:10.5826/dpc.0401a09
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