Accuracy of dermoscopic criteria for the diagnosis of melanoma in Situ

Aimilios Lallas, Caterina Longo, Marco Manfredini, Elisa Benati, Graziella Babino, Chiara Chinazzo, Zoe Apalla, Chryssoula Papageorgiou, Elvira Moscarella, Athanassios Kyrgidis, Giuseppe Argenziano

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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.

Original languageEnglish
Pages (from-to)414-419
Number of pages6
JournalJAMA Dermatology
Volume154
Issue number4
DOIs
Publication statusPublished - Apr 1 2018

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Melanoma
Nevus
Skin
Odds Ratio
Seborrheic Keratosis
Lentigo
Keratosis
Neoplasms
Lichen Planus
Basal Cell Carcinoma
Carcinoma in Situ
Skin Neoplasms
Multivariate Analysis
Retrospective Studies
Logistic Models
Research Personnel

ASJC Scopus subject areas

  • Dermatology

Cite this

Lallas, A., Longo, C., Manfredini, M., Benati, E., Babino, G., Chinazzo, C., ... Argenziano, G. (2018). Accuracy of dermoscopic criteria for the diagnosis of melanoma in Situ. JAMA Dermatology, 154(4), 414-419. https://doi.org/10.1001/jamadermatol.2017.6447

Accuracy of dermoscopic criteria for the diagnosis of melanoma in Situ. / Lallas, Aimilios; Longo, Caterina; Manfredini, Marco; Benati, Elisa; Babino, Graziella; Chinazzo, Chiara; Apalla, Zoe; Papageorgiou, Chryssoula; Moscarella, Elvira; Kyrgidis, Athanassios; Argenziano, Giuseppe.

In: JAMA Dermatology, Vol. 154, No. 4, 01.04.2018, p. 414-419.

Research output: Contribution to journalArticle

Lallas, A, Longo, C, Manfredini, M, Benati, E, Babino, G, Chinazzo, C, Apalla, Z, Papageorgiou, C, Moscarella, E, Kyrgidis, A & Argenziano, G 2018, 'Accuracy of dermoscopic criteria for the diagnosis of melanoma in Situ', JAMA Dermatology, vol. 154, no. 4, pp. 414-419. https://doi.org/10.1001/jamadermatol.2017.6447
Lallas, Aimilios ; Longo, Caterina ; Manfredini, Marco ; Benati, Elisa ; Babino, Graziella ; Chinazzo, Chiara ; Apalla, Zoe ; Papageorgiou, Chryssoula ; Moscarella, Elvira ; Kyrgidis, Athanassios ; Argenziano, Giuseppe. / Accuracy of dermoscopic criteria for the diagnosis of melanoma in Situ. In: JAMA Dermatology. 2018 ; Vol. 154, No. 4. pp. 414-419.
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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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T1 - Accuracy of dermoscopic criteria for the diagnosis of melanoma in Situ

AU - Lallas, Aimilios

AU - Longo, Caterina

AU - Manfredini, Marco

AU - Benati, Elisa

AU - Babino, Graziella

AU - Chinazzo, Chiara

AU - Apalla, Zoe

AU - Papageorgiou, Chryssoula

AU - Moscarella, Elvira

AU - Kyrgidis, Athanassios

AU - Argenziano, Giuseppe

PY - 2018/4/1

Y1 - 2018/4/1

N2 - 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.

AB - 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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