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Results of a Multicenter Study in Japan

Toshiaki Saida, MD, PhD; Atsushi Miyazaki, MD; Shinji Oguchi, MD, PhD; Yasushi Ishihara, MD; Yoriko Yamazaki, MD; Sumio Murase, MD, PhD; Shusuke Yoshikawa, MD; Tetsuya Tsuchida, MD, PhD; Yasuhiro Kawabata, MD, PhD; Kunihiko Tamaki, MD, PhD

Arch Dermatol. 2004;140:1233-1238.

Objective  To determine diagnostic variables such as sensitivity and specificity of the major dermoscopic patterns observed in melanocytic lesions on acral volar skin, with particular attention to the significance of the parallel ridge pattern and irregular diffuse pigmentation in detecting acral melanoma.

Design  Multicenter, retrospective study.

Setting  University hospitals in Japan.

Patients  Patients with melanocytic lesions on acral volar skin. A total of 712 melanocytic lesions (103 malignant melanomas, including 36 in situ lesions, and 609 melanocytic nevi) were consecutively collected from the files of 3 hospitals. Diagnoses of all the lesions had been determined histopathologically.

Interventions  Dermoscopic examination.

Main Outcome Measures  The sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic accuracy of the major dermoscopic patterns seen in benign and malignant melanocytic lesions on acral volar skin.

Results  The parallel ridge pattern and irregular diffuse pigmentation showed extremely high specificity (99.0% and 96.6%, respectively) and very high negative predictive value (97.7% and 97.5%, respectively) in malignant melanoma. For melanoma in situ, the positive predictive value and diagnostic accuracy of the parallel ridge pattern were significantly higher than those of irregular diffuse pigmentation (P = .009 and P = .006, respectively). In melanocytic nevi, the specificity and positive predictive value of the parallel furrow pattern and/or the latticelike pattern were found to be very high (93.2% and 98.3%, respectively).

Conclusions  Dermoscopy is immensely helpful in differentiating malignant melanomas from melanocytic nevi on acral volar skin. Moreover, the parallel ridge pattern aids in detecting acral melanomas in early, curable stages.

From the Departments of Dermatology (Drs Saida, Miyazaki, Oguchi, Ishihara, and Yamazaki) and Medical Informatics (Dr Murase), Shinshu University School of Medicine, Matsumoto, Japan; Department of Dermatology, Saitama Medical School, Moroyama, Japan (Drs Yoshikawa and Tsuchida); and Department of Dermatology, Faculty of Medicine, University of Tokyo, Tokyo, Japan (Drs Kawabata and Tamaki). Dr Oguchi is now with the Dermatology Clinic, Saku Central Hospital, Usuda, Nagano, Japan; Dr Ishihara is now with the Dermatology Clinic, Hokushin General Hospital, Nakano, Japan; and Dr Yoshikawa is now with the Dermatology Clinic, Shizuoka Cancer Center Hospital, Nagaizumi, Japan. The authors have no relevant financial interest in this article.

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