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Original Investigation
April 2018

Accuracy of Dermoscopic Criteria for the Diagnosis of Melanoma In Situ

Author Affiliations
  • 1First Department of Dermatology, School of Medicine, Aristotle University, Thessaloniki, Greece
  • 2Skin Cancer Unit, Arcispedale Santa Maria Nuova Istituto di Ricovero e Cura a Carattere Scientifico, Reggio Emilia, Italy
  • 3Department of Dermatology, University of Modena, Modena, Italy
  • 4Department of Dermatology, University of Campania, Naples, Italy
JAMA Dermatol. 2018;154(4):414-419. doi:10.1001/jamadermatol.2017.6447
Key Points

Question  Which dermoscopic criteria represent potent indicators for the diagnosis of melanoma in situ compared with nevi and seborrheic keratoses, solar lentigines, or lichen planus–like keratoses; pigmented superficial basal cell carcinoma; pigmented intraepidermal carcinoma; and Reed nevi?

Findings  In this diagnostic accuracy study of 1285 lesions from 1285 patients, irregular hyperpigmented areas and prominent skin markings represented potent indicators of melanoma in situ compared with atypical nevi. Atypical network, regression, and angulated lines were additional indicators of melanoma in situ compared with all other tumors.

Meaning  Because the goal of clinicians is to diagnose melanoma at the earliest possible stage, knowing the dermoscopic indicators of melanoma in situ is of paramount importance.

Abstract

Importance  The accuracy of melanoma-specific dermoscopic criteria has been tested mainly in studies including invasive tumors. Scarce evidence exists on the usefulness of these criteria for the diagnosis of melanoma in situ (MIS).

Objective  To investigate the diagnostic accuracy of dermoscopic criteria for the diagnosis of MIS.

Design, Setting, and Participants  A diagnostic accuracy study with retrospective patient enrollment was conducted in 3 centers specializing in skin cancer diagnosis and management. A total of 1285 individuals with histopathologically diagnosed MIS or other flat, pigmented skin tumors that were histopathologically diagnosed or monitored for at least 1 year were included. Dermoscopic images of MIS and other flat, pigmented skin tumors were evaluated by 3 independent investigators for the presence of predefined criteria. Evaluators were blinded to the clinic dermoscopic and histopathologic diagnosis.

Main Outcomes and Measures  Frequencies of dermoscopic criteria per diagnosis were calculated. Crude odds ratios, adjusted odds ratios, and corresponding 95% CIs were calculated by univariate and multivariate logistic regression, respectively.

Results  A total of 1285 patients were included in the study (642 [50%] male); mean age was 45.9 years (range, 9-91 years). Of a total of 1285 lesions obtained from these patients, 325 (25.3%) were MIS; 574 (44.7%) were nevi (312 [24.3%] excised and 262 [20.4%] not excised); 67 (5.2%) were seborrheic keratoses, solar lentigines, or lichen planus–like keratoses; 91 (7.1%) were pigmented superficial basal cell carcinomas; 26 (2.0%) were pigmented intraepithelial carcinomas; 100 (7.8%) were Reed nevi; and 102 (7.9%) were invasive melanomas with a Breslow thickness less than 0.75 mm. The most frequent dermoscopic criteria for MIS were regression (302 [92.9%]), atypical network (278 [85.5%]), and irregular dots and/or globules (163 [50.2%]). The multivariate analysis revealed 5 main positive dermoscopic indicators of MIS: atypical network (3.7-fold; 95% CI, 2.5-5.4), regression (4.7-fold; 95% CI, 2.8-8.1), irregular hyperpigmented areas (5.4-fold; 95% CI, 3.7-8.0), prominent skin markings (3.4-fold; 95% CI, 1.9-6.1), and angulated lines (2.2-fold; 95% CI, 1.2-4.1). When compared only with excised nevi, 2 of these criteria remained potent MIS indicators, namely, irregular hyperpigmented areas (4.3-fold; 95% CI, 2.7-6.8) and prominent skin markings (2.7-fold; 95% CI, 1.3-5.7).

Conclusions and Relevance  Clinicians should take into consideration the aforementioned dermoscopic indicators for the diagnosis of MIS.

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