title: Melanoma-associated leukoderma and vitiligo cannot be differentiated based on blinded assessment by experts in the field.
abstract: BACKGROUND
  Melanoma-associated leukoderma (MAL) is a depigmenting disorder that can occur spontaneously in patients with melanoma. The differences in clinical presentation between MAL and vitiligo are not well defined. This may lead to misdiagnosing MAL as vitiligo, resulting in delayed detection of melanoma.
  
  
  OBJECTIVE
  The objective of this study was to assess whether experts in the field can distinguish between MAL and vitiligo, and to assess if discriminative features can be identified.
  
  
  METHODS
  We designed an image comparison study in which 4 experts in the field blindly assessed photographs followed by medical history of 11 patients with MAL and 33 with vitiligo.
  
  
  RESULTS
  The assessors misdiagnosed 72.7% of MAL cases and marked 80.0% of them as typical vitiligo. The median age at onset of the leukoderma was higher (55 years, P = .001) in MAL. No discriminative features were found.
  
  
  CONCLUSIONS
  Sampling bias because of inclusion in tertiary referral center is a limitation.
  
  
  CONCLUSIONS
  The clinical presentation of leukoderma in patients with melanoma resembles that of vitiligo. We propose "melanoma-associated vitiligo" as the more appropriate term for leukoderma in patients with melanoma. Clinicians should be aware that depigmentation in vitiligo can also be caused by melanoma-associated vitiligo and a total body inspection should be performed.
authors.affiliation: Netherlands Institute for Pigment Disorders and Department of Dermatology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands. Electronic address: j.e.lommerts@amc.nl.
authors.forename: Janny E
authors.initials: JE
authors.lastname: Lommerts
authors.affiliation: Netherlands Institute for Pigment Disorders and Department of Dermatology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
authors.forename: Hansje-Eva
authors.initials: HE
authors.lastname: Teulings
authors.affiliation: Epidémiologie en Dermatologie et Evaluation des Thérapeutiques, Université Paris-Est, Service de Dermatologie, Hôpital Henri Mondor, Paris, France.
authors.forename: Khaled
authors.initials: K
authors.lastname: Ezzedine
authors.affiliation: Department of Dermatology, Ghent University Hospital, Ghent, Belgium.
authors.forename: Nanja
authors.initials: N
authors.lastname: van Geel
authors.affiliation: Department of Dermatology, University of Erlangen, Erlangen, Germany.
authors.forename: Anke
authors.initials: A
authors.lastname: Hartmann
authors.affiliation: Department of Dermatology, Ghent University Hospital, Ghent, Belgium.
authors.forename: Reinhart
authors.initials: R
authors.lastname: Speeckaert
authors.affiliation: Netherlands Institute for Pigment Disorders and Department of Dermatology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
authors.forename: Phyllis I
authors.initials: PI
authors.lastname: Spuls
authors.affiliation: Netherlands Institute for Pigment Disorders and Department of Dermatology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
authors.forename: Albert
authors.initials: A
authors.lastname: Wolkerstorfer
authors.affiliation: Netherlands Institute for Pigment Disorders and Department of Dermatology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
authors.forename: Rosalie M
authors.initials: RM
authors.lastname: Luiten
authors.affiliation: Netherlands Institute for Pigment Disorders and Department of Dermatology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
authors.forename: Marcel W
authors.initials: MW
authors.lastname: Bekkenk
mesh_terms: D000328:Adult; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D017496:Hypopigmentation / Q000175:diagnosis* / Q000209:etiology; D008297:Male; D008487:Medical History Taking; D008545:Melanoma / Q000150:complications / Q000175:diagnosis*; D008875:Middle Aged; D015588:Observer Variation; D010781:Photography; D012680:Sensitivity and Specificity; D016037:Single-Blind Method; D012878:Skin Neoplasms / Q000150:complications / Q000175:diagnosis*; D014820:Vitiligo / Q000175:diagnosis
keywords: clinical presentation; depigmentation; diagnostic accuracy; melanoma; melanoma-associated hypopigmentation; melanoma-associated leukoderma; melanoma-associated vitiligo; vitiligo