Dermoscopic evaluation of amelanotic and hypomelanotic melanoma.
OBJECTIVE
To determine the predictive dermoscopic features of amelanotic and hypomelanotic melanoma.


METHODS
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.


METHODS
Predominantly hospital-based clinics from 5 continents.


METHODS
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.
Menzies
Scott W
SW
Faculty of Medicine, University of Sydney, Sydney Melanoma Diagnostic Centre, Royal Prince Alfred Hospital, Camperdown, NSW 2050, Australia. scott.menzies@email.cs.nsw.gov.au
Kreusch
Juergen
J
Byth
Karen
K
Pizzichetta
Maria A
MA
Marghoob
Ashfaq
A
Braun
Ralph
R
Malvehy
Josep
J
Puig
Susana
S
Argenziano
Giuseppe
G
Zalaudek
Iris
I
Rabinovitz
Harold S
HS
Oliviero
Margaret
M
Cabo
Horacio
H
Ahlgrimm-Siess
Verena
V
Avramidis
Michelle
M
Guitera
Pascale
P
Soyer
H Peter
HP
Ghigliotti
Giovanni
G
Tanaka
Masaru
M
Perusquia
Ana M
AM
Pagnanelli
Gianluca
G
Bono
Riccardo
R
Thomas
Luc
L
Pellacani
Giovanni
G
Langford
David
D
Piccolo
Domenico
D
Terstappen
Karin
K
Stanganelli
Ignazio
I
Llambrich
Alex
A
Johr
Robert
R
D046169:Dermoscopy; D003937:Diagnosis, Differential; D006801:Humans; D008545:Melanoma / Q000473:pathology*; D018328:Melanoma, Amelanotic / Q000473:pathology*; D008954:Models, Biological; D015588:Observer Variation; D011237:Predictive Value of Tests; D012680:Sensitivity and Specificity; D012878:Skin Neoplasms / Q000473:pathology*; D012880:Skin Pigmentation