title: Dermoscopic evaluation of nodular melanoma.
abstract: OBJECTIVE
  Nodular melanoma (NM) is a rapidly progressing potentially lethal skin tumor for which early diagnosis is critical.
  
  
  OBJECTIVE
  To determine the dermoscopy features of NM.
  
  
  METHODS
  Eighty-three cases of NM, 134 of invasive non-NM, 115 of nodular benign melanocytic tumors, and 135 of nodular nonmelanocytic tumors were scored for dermoscopy features using modified and previously described methods. Lesions were separated into amelanotic/hypomelanotic or pigmented to assess outcomes.
  
  
  METHODS
  Predominantly hospital-based clinics from 5 continents.
  
  
  METHODS
  Sensitivity, specificity, and odds ratios for features/models for the diagnosis of melanoma.
  
  
  RESULTS
  Nodular melanoma occurred more frequently as amelanotic/hypomelanotic (37.3%) than did invasive non-NM (7.5%). Pigmented NM had a more frequent (compared with invasive non-NM; in descending order of odds ratio) symmetrical pigmentation pattern (5.8% vs 0.8%), large-diameter vessels, areas of homogeneous blue pigmentation, symmetrical shape, predominant peripheral vessels, blue-white veil, pink color, black color, and milky red/pink areas. Pigmented NM less frequently displayed an atypical broadened network, pigment network or pseudonetwork, multiple blue-gray dots, scarlike depigmentation, irregularly distributed and sized brown dots and globules, tan color, irregularly shaped depigmentation, and irregularly distributed and sized dots and globules of any color. The most important positive correlating features of pigmented NM vs nodular nonmelanoma were peripheral black dots/globules, multiple brown dots, irregular black dots/globules, blue-white veil, homogeneous blue pigmentation, 5 to 6 colors, and black color. A model to classify a lesion as melanocytic gave a high sensitivity (>98.0%) for both nodular pigmented and nonnodular pigmented melanoma but a lower sensitivity for amelanotic/hypomelanotic NM (84%). A method for diagnosing amelanotic/hypomelanotic malignant lesions (including basal cell carcinoma) gave a 93% sensitivity and 70% specificity for NM.
  
  
  CONCLUSIONS
  When a progressively growing, symmetrically patterned melanocytic nodule is identified, NM needs to be excluded.
authors.affiliation: Sydney Melanoma Diagnostic Centre, Sydney Cancer Centre, Royal Prince Alfred Hospital, Camperdown, NSW 2050, Australia. scott.menzies@sswahs.nsw.gov.au
authors.forename: Scott W
authors.initials: SW
authors.lastname: Menzies
authors.forename: Fergal J
authors.initials: FJ
authors.lastname: Moloney
authors.forename: Karen
authors.initials: K
authors.lastname: Byth
authors.forename: Michelle
authors.initials: M
authors.lastname: Avramidis
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Argenziano
authors.forename: Iris
authors.initials: I
authors.lastname: Zalaudek
authors.forename: Ralph P
authors.initials: RP
authors.lastname: Braun
authors.forename: Josep
authors.initials: J
authors.lastname: Malvehy
authors.forename: Susana
authors.initials: S
authors.lastname: Puig
authors.forename: Harold S
authors.initials: HS
authors.lastname: Rabinovitz
authors.forename: Margaret
authors.initials: M
authors.lastname: Oliviero
authors.forename: Horacio
authors.initials: H
authors.lastname: Cabo
authors.forename: Riccardo
authors.initials: R
authors.lastname: Bono
authors.forename: Maria A
authors.initials: MA
authors.lastname: Pizzichetta
authors.forename: Magdalena
authors.initials: M
authors.lastname: Claeson
authors.forename: Daniel C
authors.initials: DC
authors.lastname: Gaffney
authors.forename: H Peter
authors.initials: HP
authors.lastname: Soyer
authors.forename: Ignazio
authors.initials: I
authors.lastname: Stanganelli
authors.forename: Richard A
authors.initials: RA
authors.lastname: Scolyer
authors.forename: Pascale
authors.initials: P
authors.lastname: Guitera
authors.forename: John
authors.initials: J
authors.lastname: Kelly
authors.forename: Olivia
authors.initials: O
authors.lastname: McCurdy
authors.forename: Alex
authors.initials: A
authors.lastname: Llambrich
authors.forename: Ashfaq A
authors.initials: AA
authors.lastname: Marghoob
authors.forename: Pedro
authors.initials: P
authors.lastname: Zaballos
authors.forename: Herbert M
authors.initials: HM
authors.lastname: Kirchesch
authors.forename: Domenico
authors.initials: D
authors.lastname: Piccolo
authors.forename: Jonathan
authors.initials: J
authors.lastname: Bowling
authors.forename: Luc
authors.initials: L
authors.lastname: Thomas
authors.forename: Karin
authors.initials: K
authors.lastname: Terstappen
authors.forename: Masaru
authors.initials: M
authors.lastname: Tanaka
authors.forename: Giovanni
authors.initials: G
authors.lastname: Pellacani
authors.forename: Gianluca
authors.initials: G
authors.lastname: Pagnanelli
authors.forename: Giovanni
authors.initials: G
authors.lastname: Ghigliotti
authors.forename: Blanca Carlos
authors.initials: BC
authors.lastname: Ortega
authors.forename: Greg
authors.initials: G
authors.lastname: Crafter
authors.forename: Ana María Perusquía
authors.initials: AM
authors.lastname: Ortiz
authors.forename: Isabelle
authors.initials: I
authors.lastname: Tromme
authors.forename: Isil Kilinc
authors.initials: IK
authors.lastname: Karaarslan
authors.forename: Fezal
authors.initials: F
authors.lastname: Ozdemir
authors.forename: Anthony
authors.initials: A
authors.lastname: Tam
authors.forename: Christian
authors.initials: C
authors.lastname: Landi
authors.forename: Peter
authors.initials: P
authors.lastname: Norton
authors.forename: Nida
authors.initials: N
authors.lastname: Kaçar
authors.forename: Lidia
authors.initials: L
authors.lastname: Rudnicka
authors.forename: Monika
authors.initials: M
authors.lastname: Slowinska
authors.forename: Olga
authors.initials: O
authors.lastname: Simionescu
authors.forename: Alessandro
authors.initials: A
authors.lastname: Di Stefani
authors.forename: Elliot
authors.initials: E
authors.lastname: Coates
authors.forename: Juergen
authors.initials: J
authors.lastname: Kreusch
mesh_terms: D046169:Dermoscopy / Q000379:methods*; D018450:Disease Progression; D006801:Humans; D008545:Melanoma / Q000175:diagnosis* / Q000473:pathology; D010858:Pigmentation; D012680:Sensitivity and Specificity; D012878:Skin Neoplasms / Q000175:diagnosis* / Q000473:pathology