Dermoscopic and histopathologic diagnosis of equivocal melanocytic skin lesions: An interdisciplinary study on 107 cases

Gerardo Ferrara, Giuseppe Argenziano, H. Peter Soyer, Rosamaria Corona, Francesco Sera, Bruno Brunetti, Lorenzo Cerroni, Sergio Chimenti, Laila El Shabrawi-Caelen, Angela Ferrari, Rainer Hofmann-Wellenhof, Steven Kaddu, Domenico Piccolo, Massimiliano Scalvenzi, Stefania Staibano, Ingrid H. Wolf, Gaetano De Rosa

Research output: Contribution to journalArticlepeer-review


BACKGROUND. Dermoscopy (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. METHODS. One 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. RESULTS. The 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. CONCLUSIONS. At 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.

Original languageEnglish
Pages (from-to)1094-1100
Number of pages7
Issue number5
Publication statusPublished - Sep 1 2002


  • Dermatoscopy
  • Dermoscopy
  • Diagnosis
  • Epiluminescence microscopy
  • Histopathology
  • Interobserver agreement
  • Melanocytic skin lesions
  • Melanoma

ASJC Scopus subject areas

  • Cancer Research
  • Oncology


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