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Jin Xu, BS; Kapil Gupta, PhD; William V. Stoecker, MS, MD; Yamini Krishnamurthy; Harold S. Rabinovitz, MD; Austin Bangert, BS; David Calcara, BS; Margaret Oliviero, ARNP; Joseph M. Malters, MD; Rhett Drugge, MD; R. Joe Stanley, PhD; Randy H. Moss, PhD; M. Emre Celebi, PhD

Arch Dermatol. 2009;145(11):1245-1251.

Objective  To identify and analyze subtypes of globules based on size, shape, network connectedness, pigmentation, and distribution to determine which globule types and globule distributions are most frequently associated with a diagnosis of malignant melanoma.

Design  Retrospective case series of dermoscopy images with globules.

Setting  Private dermatology practices.

Participants  Patients in dermatology practices.

Intervention  Observation only.

Main Outcome Measure  Association of globule types with malignant melanoma.

Results  The presence of large globules (odds ratio [OR], 5.25) and globules varying in size (4.72) or shape (5.37) had the highest ORs for malignant melanoma among all globule types and combinations studied. Classical globules (dark, discrete, convex, and 0.10-0.20 mm) had a higher risk (OR, 4.20) than irregularly shaped globules (dark, discrete, and not generally convex) (2.89). Globules connected to other structures were not significant in the diagnosis of malignant melanoma. Of the different configurations studied, asymmetric clusters have the highest risk (OR, 3.02).

Conclusions  The presence of globules of varying size or shape seems to be more associated with a diagnosis of malignant melanoma than any other globule type or distribution in this study. Large globules are of particular importance in the diagnosis of malignant melanoma.

Author Affiliations: Stoecker and Associates (Ms Xu, Mr Calcara, Drs Gupta and Stoecker, and Ms Krishnamurthy); The Dermatology Center (Dr Malters), and Department of Electrical and Computer Engineering, Missouri University of Science and Technology (Mr Bangert and Drs Stanley and Moss), Rolla, Missouri; Skin and Cancer Associates, Plantation, Florida (Dr Rabinovitz and Ms Oliviero); and Department of Computer Science, Louisiana State University, Shreveport (Dr Celebi). Dr Drugge is in private practice in Stamford, Connecticut.

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