TY - JOUR
T1 - Dermoscopic and histopathologic diagnosis of equivocal melanocytic skin lesions
T2 - An interdisciplinary study on 107 cases
AU - Ferrara, Gerardo
AU - Argenziano, Giuseppe
AU - Soyer, H. Peter
AU - Corona, Rosamaria
AU - Sera, Francesco
AU - Brunetti, Bruno
AU - Cerroni, Lorenzo
AU - Chimenti, Sergio
AU - El Shabrawi-Caelen, Laila
AU - Ferrari, Angela
AU - Hofmann-Wellenhof, Rainer
AU - Kaddu, Steven
AU - Piccolo, Domenico
AU - Scalvenzi, Massimiliano
AU - Staibano, Stefania
AU - Wolf, Ingrid H.
AU - De Rosa, Gaetano
PY - 2002/9/1
Y1 - 2002/9/1
N2 - 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.
AB - 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.
KW - Dermatoscopy
KW - Dermoscopy
KW - Diagnosis
KW - Epiluminescence microscopy
KW - Histopathology
KW - Interobserver agreement
KW - Melanocytic skin lesions
KW - Melanoma
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U2 - 10.1002/cncr.10768
DO - 10.1002/cncr.10768
M3 - Article
C2 - 12209696
AN - SCOPUS:0036721044
VL - 95
SP - 1094
EP - 1100
JO - Cancer
JF - Cancer
SN - 0008-543X
IS - 5
ER -