title: Interobserver agreement on dermoscopic features of small basal cell carcinoma (<5 mm) among low-experience dermoscopists.
abstract: The basal cell carcinoma (BCC) assessment in dermoscopy is based on the recognition of specific characteristics synthesized and described as classical and non-classical criteria, but which may not necessarily present all at the same time. Consequently, a deep knowledge in detecting the aforementioned dermoscopic criteria is crucial in diagnosis. The aim of the study was to evaluate which criteria are more frequently recognized among a group of low-experienced dermoscopists when confronted with the difficult diagnosis of BCC with a diameter lower than 5 mm. We examined 100 BCC finding that data displays a full agreement only for one classical criterion, the lack of pigmented network (Fleiss' κ = 1), while among other classical criteria only arborizing vessels and ulceration exhibit a good agreement among observers (Fleiss' κ > 0.40). Analyzing non-classical criteria, only blue-whitish veil and blue in-focus dots show a good agreement among low-experience observers (Fleiss' κ > 0.40). It is evident that in small size BCC classic dermoscopic criteria are often substituted by non-classical criteria, which represent the neoplasm's early phase. Thus, it is of importance, especially for low-experience dermoscopists, to analyze even the non-classical criteria in order to obtain a diagnosis of early BCC.
authors.affiliation: Dermatology Department, University of Trieste, Trieste, Italy.
authors.forename: Nicola
authors.initials: N
authors.lastname: di Meo
authors.affiliation: Dermatology Department, University of Trieste, Trieste, Italy. dr.giovanni.damiani@gmail.com.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Damiani
authors.affiliation: Dermatology Department, University of Trieste, Trieste, Italy.
authors.forename: Silvia
authors.initials: S
authors.lastname: Vichi
authors.affiliation: Dermatology Department, University of Trieste, Trieste, Italy.
authors.forename: Mattia
authors.initials: M
authors.lastname: Fadel
authors.affiliation: Dermatology Department, University of Trieste, Trieste, Italy.
authors.forename: Katiuscia
authors.initials: K
authors.lastname: Nan
authors.affiliation: Dermatology Department, University of Trieste, Trieste, Italy.
authors.forename: Cecilia
authors.initials: C
authors.lastname: Noal
authors.affiliation: Dermatology Department, University of Trieste, Trieste, Italy.
authors.forename: Sara
authors.initials: S
authors.lastname: Trevisini
authors.affiliation: Dermatology Department, University of Trieste, Trieste, Italy.
authors.forename: Giusto
authors.initials: G
authors.lastname: Trevisan
mesh_terms: D000368:Aged; D002280:Basal Cell Carcinoma / Q000000981:diagnostic imaging*; D046169:Dermoscopy / Q000592:standards*; D055088:Early Detection of Cancer / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D015588:Observer Variation; D011897:Random Allocation; D012878:Skin Neoplasms / Q000000981:diagnostic imaging*
keywords: basal cell carcinomas; classical criteria; consensus agreement; dermoscopy; low experience