title: Morphologic changes of pigmented skin lesions: a useful extension of the ABCD rule for dermatoscopy.
abstract: BACKGROUND
  Epiluminescence microscopy (ELM) significantly increases the early diagnosis of pigmented skin lesions (PSL) using established criteria and pattern analysis. The ABCD rule for dermatoscopy (ie, ELM) provides a simplified approach to the interpretation of ELM images on the basis of asymmetry (A), border (B), color (C), and dermatoscopic structure (D).
  
  
  OBJECTIVE
  We set out to determine whether the diagnostic accuracy of the ABCD scoring algorithm can be significantly improved by incorporating information about morphologic changes of the lesion observed and provided by the patient.
  
  
  METHODS
  We prospectively collected 356 small pigmented skin lesions (< 1 cm) including 73 (20.5%) melanomas. Before excision all patients were asked whether the lesion had changed in size, color, or shape within the last year or whether they experienced any sign of ulceration or spontaneous bleeding. ELM images of the lesions were evaluated according to the ABCD rule for dermatoscopy to yield a semiquantitative score. Accuracy of diagnosis was evaluated in terms of sensitivity, specificity, and area under receiver operating characteristic curves (AUC).
  
  
  RESULTS
  The frequency of reported changes was significantly higher for melanomas than benign PSL (65.8% vs 29.7%, P < .001). In a multivariate model morphologic change was a significant independent predictor of malignancy (odds ratio = 3.17, 95% confidence interval [CI]: 1.96 to 5.14, P < .001). The mean final score achieved when using the enhanced ABCD-E criteria including morphologic change (E) was significantly higher for melanomas (5.7, 95% CI: 5.3 to 6.0) than benign PSL (2.9, 95% CI: 2.8 to 3.1, P < .001). Diagnostic accuracy was significantly higher when the lesions were evaluated by the enhanced ABCD-E criteria as compared with the standard ABCD score (AUC(ABCD) = 0.87 vs AUC(ABCD-E) = 0.90; P = .006).
  
  
  CONCLUSIONS
  Information about morphologic changes of PSL as reported by the patient is a useful extension of the ABCD rule for dermatoscopy.
authors: Department of Dermatology, University of Vienna Medical School, Austria.
authors: H
authors: H
authors: Kittler
authors: M
authors: M
authors: Seltenheim
authors: M
authors: M
authors: Dawid
authors: H
authors: H
authors: Pehamberger
authors: K
authors: K
authors: Wolff
authors: M
authors: M
authors: Binder
mesh_terms: D000328:Adult; D000368:Aged; D002471:Cell Transformation, Neoplastic / Q000473:pathology*; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D008297:Male; D008545:Melanoma / Q000473:pathology*; D008853:Microscopy; D008875:Middle Aged; D009508:Nevus, Pigmented / Q000473:pathology*; D010859:Pigmentation Disorders / Q000473:pathology*; D011237:Predictive Value of Tests; D012867:Skin / Q000473:pathology; D012878:Skin Neoplasms / Q000473:pathology*