Davide Altamura

Assessment of the Optimal Interval for and Sensitivity of Short-term Sequential Digital Dermoscopy Monitoring for the Diagnosis of Melanoma

OBJECTIVE To determine whether 6 weeks could replace 3 months for short-term sequential digital dermoscopy imaging (ST-SDDI) of suspicious melanocytic lesions and determine the proportion of melanomas missed. DESIGN Consecutive lesions (n = 2602) undergoing ST-SDDI monitored from 1859 patients were included. Half of the patients underwent 6-week monitoring followed by 3-month monitoring (range, 2.5-4.5 months) if changes were not seen. The remainder underwent 3-month monitoring only. Any change during this time led to excision. Lesions unchanged were then followed up over time. SETTING A tertiary referral institution. MAIN OUTCOME MEASURES The proportion of changed melanomas (sensitivity) and odds ratios (ORs) for melanoma of changed lesions. RESULTS Eighty-one melanomas were detected using ST-SDDI (Breslow thickness: median, in situ; maximum, 0.8 mm). Of 39 melanomas detected using ST-SDDI in the 6-week monitored lesions, 27 (69%) were detected at 6 weeks and 12 (31%) at 3 months. The OR for melanoma for a lesion changing at 6 weeks was 19 (95% confidence interval [CI], 10-35), and the overall OR for melanoma for a lesion changing during the short-term monitoring period (6 weeks to 4.5 months) was 47 (95% CI, 23-94). For lesions remaining unchanged at 3 months, 99.2% (1118 of 1127 lesions) were shown to be benign as defined by an unremarkable further follow-up. Seventy-five percent (15 of 20) of the lentigo maligna melanomas, 93% (40 of 43) of other in situ melanomas, and 96% (26 of 27) of the invasive melanomas were detected using ST-SDDI. Conclusion Three months remains the standard interval for ST-SDDI, where the sensitivity for the diagnosis of melanoma for changed (non-lentigo maligna) lesions is high but not 100%.

Variables Predicting Change in Benign Melanocytic Nevi Undergoing Short-term Dermoscopic Imaging

OBJECTIVE To determine whether certain patient demographics are associated with poorer specificity for the diagnosis of melanoma in nevi undergoing short-term sequential digital dermoscopic imaging. DESIGN Retrospective cohort study performed from April 1, 1998, through May 31, 2007. SETTING Sydney Melanoma Diagnostic Centre, a tertiary referral institution. PATIENTS A total of 2497 benign melanocytic lesions in 1765 patients undergoing short-term sequential digital dermoscopic imaging during 2.5 to 4.5 months (42.3% male; mean [SD] age, 40 [14] years; age range, 1-86 years). MAIN OUTCOME MEASURES Proportion of changed nevi as a function of age, sex, lesion diameter, and anatomical site. RESULTS The only variable significantly associated with nevus change was age group (P = .002). When compared with the middle-aged (aged 36-50 years) group, the odds of change were significantly increased in the child and adolescent (aged 0-18 years: odds ratio, 2.60; 95% confidence interval, 1.30-5.22), young adult (aged 19-35 years: 1.50; 1.04-2.17), and elderly (> 65 years old: 2.04; 1.04-3.99) age groups. Within the changed benign lesions, a significant association was observed between histologic subtype and age group (P = .01). The proportion of changed lesions of the banal nevi type decreased and the proportion of the dysplastic nevi type increased with age. In the elderly group, 75.9% of changed lesions were of the dysplastic nevi type compared with 35.7% in the youngest group. CONCLUSION A poorer specificity is observed for the diagnosis of melanoma for nevi undergoing short-term sequential digital dermoscopic imaging in children and adolescents (75.7%) and elderly patients (77.9%) compared with other patients (84.6%).

The Significance of Eccentric and Central Hyperpigmentation, Multifocal Hyper/hypopigmentation, and the Multicomponent Pattern in Melanocytic Lesions Lacking Specific Dermoscopic Features of Melanoma

OBJECTIVE To examine the significance of eccentric hyperpigmentation (EH), central hyperpigmentation (CH), multifocal hyper/hypopigmentation (MH/HP), and the multicomponent pattern (MCP) in melanocytic lesions lacking specific dermoscopic features of melanoma. DESIGN A total of 3367 benign and malignant melanocytic lesions (n = 341 melanomas, excluding lentigo maligna and lentigo maligna melanoma) were examined to identify those lesions lacking specific dermoscopic features of melanoma but having any of the global patterns of EH, CH, MH/HP, and MCP. SETTING Dermoscopic images were collected from lesions excised or undergoing sequential digital monitoring from the Sydney Melanoma Diagnostic Centre, a tertiary referral institution located in Sydney, Australia. MAIN OUTCOME MEASURE The odds ratio (OR) for melanoma of EH, CH, MH/HP, and MCP. RESULTS While EH (OR, 3.3; 95% confidence interval [CI], 2.5-4.6) and MCP (OR, 15.4; 95% CI, 11.9-19.9) were significant predictors of melanoma when total melanomas vs nevi were analyzed, there was no significant difference between the frequency of any of the global patterns in melanomas vs benign nevi lacking specific dermoscopic features of melanoma. CONCLUSION Based on our study results and previous prevalence data on these global patterns in benign nevi, we do not believe that lesions with EH or MCP require closer observation than other benign nevi lacking specific dermoscopic features of melanoma.

Computer-automated ABCD versus dermatologists with different degrees of experience in dermoscopy

BackgroundDermoscopy is a very useful and non-invasive technique for in vivo observation and preoperative diagnosis of pigmented skin lesions (PSLs) inasmuch as it enables analysis of surface and subsurface structures that are not discernible to the naked eye.MethodsThe authors used the ABCD rule of dermoscopy to test the accuracy of melanoma diagnosis with respect to a panel of 165 PSLs and the intra- and inter-observer diagnostic agreement obtained between three dermatologists with different degrees of experience, one General Practitioner and a DDA for computer-assisted diagnosis (Nevuscreen®, Arkè s.a.s., Avezzano, Italy).Results165 Pigmented Skin Lesions from 165 patients were selected. Histopathological examination revealed 132 benign melanocytic skin lesions and 33 melanomas. The kappa statistic, sensitivity, specificity and predictive positive and negative values were calculated to measure agreement between all the human observers and in comparison with the automated DDA.ConclusionOur results revealed poor reproducibility of the semi-quantitative algorithm devised by Stolz et al. independently of observers’ experience in dermoscopy. Nevuscreen® (Arkè s.a.s., Avezzano, Italy) proved to be ‘user friendly’ to all observers, thus enabling a more critical evaluation of each lesion and representing a helpful tool for clinicians without significant experience in dermoscopy in improving and achieving more accurate diagnosis of PSLs.

Pigmented reticular structures in basal cell carcinoma and collision tumours

Background  The dermatoscopic diagnosis of basal cell carcinoma (BCC) is based on well‐known specific criteria. Despite the fact that a pigment network is considered a negative feature for the diagnosis of BCC, its detection in a BCC context has been reported in 2·8% of cases.

Dermoscopic evolution of vascular pattern in two cases of amelanotic melanoma

Hypo/amelanotic skin lesions present a diagnostic chal-lenge, and dermoscopic analysis can often help in deter-mining whether a lesion is benign or malignant (1–3). The presence of a vascular pattern characterized by poly-morphic vessels, such as hairpin-like, pinpoint and linear irregular vessels, may be the only significant dermoscopic finding of amelanotic melanoma (AM) (4).As described previously, morphological changes in dermoscopic patterns have been associated with the characteristic evolution of benign melanocytic naevi after a long-term follow-up of 12 months (5, 6). Rapid and irregular modifications often suggest malignancy (6). The diagnosis of early-phase AM is especially challenging. We report here two cases of AM characterized by der-moscopic changes in vascular pattern observed during a follow-up period of 6–10 months after the initial visit.CASE REPORTS