title: A risk scoring system for the differentiation between melanoma with regression and regressing nevi.
abstract: BACKGROUND
  Spontaneous regression of melanomas is relatively common, its prevalence ranging from 10 to 35%. However, regressing nevi can exhibit worrisome feature and simulate melanoma both clinically and dermoscopically. Thus, the presence of regression can represent a confounding factor.
  
  
  OBJECTIVE
  To investigate the frequency of dermoscopic patterns of "regression" in a series of benign and malignant melanocytic skin lesions, and to design an integrated scoring system. Scoring classifiers are very effective in selecting the significant parameters for discriminating two clinical conditions, thus can rapidly calculate a patient's risk for a given disease.
  
  
  METHODS
  We selected a series of 95 regressing melanocytic lesions, including 50 regressing nevi and 45 melanomas with regression. For each lesion, 12 dermoscopic variables (i.e. five types of regression structures, five atypical pigmentation structures, atypical vascular pattern and pink areas) were examined by three expert in dermoscopy (blinded to the histological diagnosis). The dermoscopic evaluation was then combined with patient age, gender, body site and the maximum diameter of lesion. Concordance analysis with Cohen's kappa was performed between the three clinicians. A risk scoring system was designed by the leave-one-out cross-validation procedure to ensure model prediction power.
  
  
  RESULTS
  The predictive score model revealed a sensitivity of 97.8% and a specificity of 75.5% in discriminating nevi and melanomas with regression. Using the score model, the diagnostic performance of the examiners increased by an average of 23.7% in sensitivity and 5.9% in specificity, compared with standard dermoscopic pattern analysis.
  
  
  CONCLUSIONS
  We assessed the validity of an integrated risk scoring model as a new methodological approach that could help the dermatologist in the differentiation between melanoma with regression and regressing nevus. Future studies could test the setting up of a score model over an even more complex pool of data obtained from different skin lesions with various diagnostic devices.
authors.affiliation: Dermatology Unit, Department of Medical, Surgical and Neurosciences, University of Siena, AOUS "Le Scotte", Siena, Italy.
authors.forename: P
authors.initials: P
authors.lastname: Rubegni
authors.affiliation: Dermatology Unit, Department of Medical, Surgical and Neurosciences, University of Siena, AOUS "Le Scotte", Siena, Italy. Electronic address: linda.tognetti@gmail.com.
authors.forename: L
authors.initials: L
authors.lastname: Tognetti
authors.affiliation: Dermatology Unit, Department of Mental and Physic Health and Preventive Medicine, Second University of Naples, Naples, Italy.
authors.forename: G
authors.initials: G
authors.lastname: Argenziano
authors.affiliation: Dermatology Unit, Department of Medical, Surgical and Neurosciences, University of Siena, AOUS "Le Scotte", Siena, Italy.
authors.forename: N
authors.initials: N
authors.lastname: Nami
authors.affiliation: Dermatology Unit, Department of Mental and Physic Health and Preventive Medicine, Second University of Naples, Naples, Italy.
authors.forename: G
authors.initials: G
authors.lastname: Brancaccio
authors.affiliation: Dermatology Department-University Hospital of Saint-Etienne, Saint-Etienne, France.
authors.forename: E
authors.initials: E
authors.lastname: Cinotti
authors.affiliation: Section of Human Patology, University of Siena, Siena, Italy.
authors.forename: C
authors.initials: C
authors.lastname: Miracco
authors.affiliation: Dermatology Unit, Department of Medical, Surgical and Neurosciences, University of Siena, AOUS "Le Scotte", Siena, Italy.
authors.forename: M
authors.initials: M
authors.lastname: Fimiani
authors.affiliation: Department of Medical Biotechnologies, University of Siena, Siena, Italy.
authors.forename: G
authors.initials: G
authors.lastname: Cevenini
mesh_terms: D000293:Adolescent; D000328:Adult; D046169:Dermoscopy; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D008297:Male; D008545:Melanoma / Q000000981:diagnostic imaging*; D008875:Middle Aged; D009365:Neoplasm Regression, Spontaneous; D009508:Nevus, Pigmented / Q000000981:diagnostic imaging*; D012107:Research Design; D012189:Retrospective Studies; D012306:Risk; D012680:Sensitivity and Specificity; D012878:Skin Neoplasms / Q000000981:diagnostic imaging*; D055815:Young Adult
keywords: Dermoscopy; Melanoma; Regression; Risk score model