title: The BRAAFF checklist: a new dermoscopic algorithm for diagnosing acral melanoma.
abstract: BACKGROUND
  The parallel ridge pattern (PRP) is considered the dermoscopic hallmark of acral melanoma (AM). However, it was recently shown that approximately one-third of AMs do not display a PRP dermoscopically, rendering their detection more troublesome.
  
  
  OBJECTIVE
  To investigate the diagnostic accuracy of dermoscopic criteria for the diagnosis of AM.
  
  
  METHODS
  Dermoscopic images of consecutive cases of histopathologically diagnosed AMs and acral naevi with histopathological diagnosis or with at least 1 year of follow-up were evaluated by three independent investigators for the presence of predefined criteria. Crude and adjusted odds ratios and their corresponding 95% confidence intervals were calculated by univariate and multivariate logistic regression, respectively. Receiver operating characteristic curves were used to choose among competing classification schemes.
  
  
  RESULTS
  In total 603 lesions (472 naevi and 131 AMs) were included in the study. A scoring system (named BRAAFF) composed of six variables was associated with optimal area under the curve and sensitivity for the diagnosis of AM. This method includes four positive (irregular blotches, ridge pattern, asymmetry of structures and asymmetry of colours) and two negative predictors (furrow pattern and fibrillar pattern).
  
  
  CONCLUSIONS
  The BRAAFF checklist significantly improves the diagnostic accuracy of dermoscopy for the diagnosis of AM.
authors.affiliation: Skin Cancer Unit, Arcispedale Santa Maria Nuova IRCCS, Viale Risorgimento 80, 42100, Reggio Emilia, Italy.
authors.forename: A
authors.initials: A
authors.lastname: Lallas
authors.affiliation: Skin Cancer Unit, Arcispedale Santa Maria Nuova IRCCS, Viale Risorgimento 80, 42100, Reggio Emilia, Italy.
authors.forename: A
authors.initials: A
authors.lastname: Kyrgidis
authors.affiliation: Department of Dermatology, Shinshu University School of Medicine, Matsumoto, Japan.
authors.forename: H
authors.initials: H
authors.lastname: Koga
authors.affiliation: Skin Cancer Unit, Arcispedale Santa Maria Nuova IRCCS, Viale Risorgimento 80, 42100, Reggio Emilia, Italy.
authors.forename: E
authors.initials: E
authors.lastname: Moscarella
authors.affiliation: Division of General Dermatology, Department of Dermatology, Medical University, Vienna, Austria.
authors.forename: P
authors.initials: P
authors.lastname: Tschandl
authors.affiliation: First Department of Dermatology, Medical School, Aristotle University, Thessaloniki, Greece.
authors.forename: Z
authors.initials: Z
authors.lastname: Apalla
authors.affiliation: Division of Dermatology, Complesso Integrato Columbus, Rome, Italy.
authors.forename: A
authors.initials: A
authors.lastname: Di Stefani
authors.affiliation: Department of Dermatology, Shinshu University School of Medicine, Matsumoto, Japan.
authors.forename: D
authors.initials: D
authors.lastname: Ioannides
authors.affiliation: First Department of Dermatology, Medical School, Aristotle University, Thessaloniki, Greece.
authors.forename: H
authors.initials: H
authors.lastname: Kittler
authors.affiliation: Department of Dermatology, Tokyo Women's Medical University Medical Center East, Tokyo, Japan.|Kobayashi Clinic, Tokyo, Japan.
authors.forename: K
authors.initials: K
authors.lastname: Kobayashi
authors.affiliation: Department of Dermatology, Shinshu University School of Medicine, Matsumoto, Japan.
authors.forename: E
authors.initials: E
authors.lastname: Lazaridou
authors.affiliation: Skin Cancer Unit, Arcispedale Santa Maria Nuova IRCCS, Viale Risorgimento 80, 42100, Reggio Emilia, Italy.
authors.forename: C
authors.initials: C
authors.lastname: Longo
authors.affiliation: Department of Dermatology, Claude Bernard - Lyon 1 University, Centre Hospitalier Lyon-Sud, Pierre Bénite, France.
authors.forename: A
authors.initials: A
authors.lastname: Phan
authors.affiliation: Division of General Dermatology, Department of Dermatology, Medical University, Vienna, Austria.
authors.forename: T
authors.initials: T
authors.lastname: Saida
authors.affiliation: Department of Dermatology, Tokyo Women's Medical University Medical Center East, Tokyo, Japan.
authors.forename: M
authors.initials: M
authors.lastname: Tanaka
authors.affiliation: Department of Dermatology, Claude Bernard - Lyon 1 University, Centre Hospitalier Lyon-Sud, Pierre Bénite, France.
authors.forename: L
authors.initials: L
authors.lastname: Thomas
authors.affiliation: Department of Dermatology and Venereology, Medical University, Graz, Austria.
authors.forename: I
authors.initials: I
authors.lastname: Zalaudek
authors.affiliation: Dermatology Unit, Second University of Naples, Naples, Italy.
authors.forename: G
authors.initials: G
authors.lastname: Argenziano
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000465:Algorithms; D057189:Checklist; D002648:Child; D002675:Child, Preschool; D046169:Dermoscopy / Q000379:methods*; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D008545:Melanoma / Q000473:pathology*; D008875:Middle Aged; D015588:Observer Variation; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D012878:Skin Neoplasms / Q000473:pathology*; D055815:Young Adult