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Scott W. Menzies, MB, BS, PhD; Juergen Kreusch, PhD, MD; Karen Byth, PhD; Maria A. Pizzichetta, MD; Ashfaq Marghoob, MD; Ralph Braun, MD; Josep Malvehy, MD; Susana Puig, MD; Giuseppe Argenziano, MD; Iris Zalaudek, MD; Harold S. Rabinovitz, MD; Margaret Oliviero, ARNP; Horacio Cabo, MD; Verena Ahlgrimm-Siess, MD; Michelle Avramidis, BSc; Pascale Guitera, MD; H. Peter Soyer, MD; Giovanni Ghigliotti, MD; Masaru Tanaka, MD; Ana M. Perusquia, MD; Gianluca Pagnanelli, MD; Riccardo Bono, MD; Luc Thomas, MD, PhD; Giovanni Pellacani, MD; David Langford, MB, ChB; Domenico Piccolo, MD; Karin Terstappen, MD; Ignazio Stanganelli, MD; Alex Llambrich, MD; Robert Johr, MD

Arch Dermatol. 2008;144(9):1120-1127.

Objective  To determine the predictive dermoscopic features of amelanotic and hypomelanotic melanoma.

Design  A total of 105 melanomas (median Breslow thickness, 0.76 mm), 170 benign melanocytic lesions, and 222 nonmelanocytic lesions lacking significant pigment (amelanotic, partially pigmented, and light colored) were imaged using glass-plate dermoscopy devices and scored for 99 dermoscopic features. Diagnostic models were derived from and tested on independent randomly selected lesions.

Setting  Predominantly hospital-based clinics from 5 continents.

Main Outcome Measures  Sensitivity, specificity, and odds ratios for individual features and models for the diagnosis of melanoma and malignancy.

Results  The most significant negative predictors of melanoma were having multiple (>3) milialike cysts (odds ratio, 0.09; 95% confidence interval, 0.01-0.64), comma vessels with a regular distribution (0.10; 0.01-0.70), comma vessels as the predominant vessel type (0.16; 0.05-0.52), symmetrical pigmentation pattern (0.18; 0.09-0.39), irregular blue-gray globules (0.20; 0.05-0.87), and multiple blue-gray globules (0.28; 0.10-0.81). The most significant positive predictors were having a blue-white veil (odds ratio,13; 95% confidence interval, 3.9-40.0), scarlike depigmentation (4.4; 2.4-8.0), multiple blue-gray dots (3.5; 1.9-6.4), irregularly shaped depigmentation (3.3; 2.0-5.3), irregular brown dots/globules (3.2; 1.8-5.6), 5 to 6 colors (3.2; 1.6-6.3), and predominant central vessels (3.1; 1.6-6.0). A simple model distinguishing melanomas from all nonmelanomas had a sensitivity of 70% and a specificity of 56% in the test set. A model distinguishing all malignant lesions from benign lesions had a sensitivity of 96% and a specificity of 37%.

Conclusion  Although the diagnostic accuracy of dermoscopy for melanoma lacking significant pigment is inferior to that of more pigmented lesions, features distinguishing the former from benign lesions can be visualized on dermoscopic evaluation.

Author Affiliations: Faculty of Medicine, University of Sydney (Dr Menzies), Sydney Melanoma Diagnostic Centre (Drs Menzies and Guitera and Ms Avramidis), and National Health and Medical Research Council Clinical Trials Centre (Dr Byth), Sydney, Australia; Centro di Riferimento Oncologico, Aviano, Italy (Dr Pizzichetta); Memorial Sloan-Kettering Cancer Center, New York, New York (Dr Marghoob); Departments of Dermatology, University Hospital Zurich, Zurich, Switzerland (Dr Braun); Second University of Naples, Naples, Italy (Dr Argenziano); Medical University of Graz, Graz, Austria (Drs Zalaudek and Ahlgrimm-Siess); Tokyo Women's Medical University Medical Center, Tokyo, Japan (Dr Tanaka); Knappschaftskrankenhaus Recklinghausen and Hospital Español, Mexico City, Mexico (Dr Perusquia); Lyon 1 University, Lyon, France (Dr Thomas); University of Modena and Reggio Emilia, Modena, Italy (Dr Pellacani); University of l’Aquila, l’Aquila, Italy (Dr Piccolo); Kärnsjukhuset, Skaraborg Hospital, Skörde, Sweden (Dr Terstappen); and Fundació Hospital Son Llàtzer, Palma de Mallorca, Spain (Dr Llambrich); Melanoma Unit, Department of Dermatology, Hospital Clinic, Institut d’Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spain (Drs Malvehy and Puig); Skin and Cancer Associates, Plantation, Florida (Dr Rabinovitz and Ms Oliviero); Hospital de Clinicas, University of Buenos Aires, Buenos Aires, Argentina (Dr Cabo); Dermatology Institute, University of Queensland, Queensland, Australia (Dr Soyer); Division of Dermatology, San Martino Hospital, Genoa, Italy (Dr Ghigliotti); Istituto Dermopatico Immacolata, Istituto di Ricovero e Cura a Carattere Scientifico, Rome, Italy (Drs Pagnanelli and Bono); Skin Cancer Unit, Ospedale Niguarda Ca’ Granda, Istituto Scientifico per lo Studio e la Cura dei Tumori, Milan, Italy (Dr Stanganelli); and Pigmented Lesion Clinic, University of Miami School of Medicine, Miami, Florida (Dr Johr). Dr Kreusch is in private practice in Lubeck, Germany, and Dr Langford is in private practice in Christchurch, New Zealand.

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