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A Morphological Study

Pedro Zaballos, MD; Cinta Daufí, MD; Susana Puig, PhD; Giuseppe Argenziano, MD; David Moreno-Ramírez, MD; Horacio Cabo, MD; Ashfaq A. Marghoob, MD; Álex Llambrich, MD; Iris Zalaudek, MD; Josep Malvehy, MD

Arch Dermatol. 2007;143(3):318-325.

Objectives  To describe the dermoscopic structures and patterns associated with solitary angiokeratomas and to determine the sensitivity, specificity, positive predictive value, negative predictive value, and reproducibility of these dermoscopic features.

Design  Multicenter retrospective study.

Setting  University hospitals in Spain, Italy, Argentina, New York City, and Austria.

Patients  There were 256 patients total, and 32 specimens each of solitary angiokeratomas, melanocytic nevi, Spitz-Reed nevi, malignant melanomas, pigmented basal cell carcinomas, dermatofibromas, seborrheic keratoses, and other vascular lesions (19 angiomas, 7 pyogenic granulomas, 3 spider nevi, 2 lymphangiomas, and 1 venous lake) were consecutively collected from the laboratories of 8 hospitals. Diagnoses of all patients' lesions were confirmed histopathologically.

Intervention  Dermoscopic examination.

Main Outcome Measures  The frequency, sensitivity, specificity, positive predictive value, negative predictive value, intraobserver agreement, and interobserver agreement of the different dermoscopic features associated with solitary angiokeratomas were calculated, and the differences were evaluated using the ² or Fisher exact test.

Results  Six dermoscopic structures were evident in at least 50% of the solitary angiokeratomas: dark lacunae (94%), whitish veil (91%), erythema (69%), peripheral erythema (53%), red lacunae (53%), and hemorrhagic crusts (53%). Dark lacunae exhibited a sensitivity of 93.8% and a specificity of 99.1% (P<.001 for both), not being found in malignant melanomas or pigmented basal cell carcinomas. The positive predictive value was 93.8%, and the negative predictive value was 99.1%. The intraobserver agreement was perfect (, 1.00), and the interobserver agreement was excellent ( range, 0.83-1.00) (P<.001 for both). Pattern 1, consisting of dark lacunae and whitish veil, exhibited a sensitivity of 84.4% and a specificity of 99.1% and was not found in malignant melanomas or pigmented basal cell carcinomas. The positive predictive value was 93.1%, the negative predictive value was 97.8%, the intraobserver agreement was perfect (, 1.00), and the interobserver agreement was excellent ( range, 0.83-1.00) (P<.001 for all).

Conclusion  Dermoscopy is helpful in improving the diagnostic accuracy of solitary angiokeratomas and allows the observer to differentiate them from other cutaneous tumors such as malignant melanomas and pigmented basal cell carcinomas.

Author Affiliations: Departments of Dermatology (Dr Zaballos) and Epidemiology (Dr Daufí), Hospital Sant Pau i Santa Tecla, Tarragona; Department of Dermatology, Hospital Clinic of Barcelona, Barcelona (Drs Puig and Malvehy); Department of Dermatology, Hospital Virgen Macarena, Sevilla (Dr Moreno-Ramírez); and Department of Dermatology, Hospital de Son Llatzer, Palma de Mallorca (Dr Llambrich); Spain; Department of Dermatology, Second University of Naples, Naples, Italy (Dr Argenziano); Department of Dermatology, Instituto de Investigaciones Médicas "A. Lanari," Buenos Aires, Argentina (Dr Cabo); Department of Dermatology, Memorial Sloan-Kettering Cancer Center, New York, NY (Dr Marghoob); and Department of Dermatology, Medical University of Graz, Graz, Austria (Dr Zalaudek).

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