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.
    Full-text · Article · Apr 2014
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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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    Full-text · Article · Jan 2014
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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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