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Diagnostic accuracy of melanoma specific structures[1-4]

Diagnostic accuracy of melanoma specific structures[1-4]
Melanoma specific structure Sensitivity (percent) Specificity (percent) Positive predictive value (percent) Negative predictive value (percent) Odds ratio*
Amelanotic melanoma Pigmented melanoma
1. Atypical network[1,3,5-14] 21 35-82 62-89 18-67 71-88 1.1-9
2. Peripheral streaks (pseudopods and radial streaming)[1,3,5-10,13-15] 5 9-32 77-99 22-77 54-86 1.6-5.8
3. Negative pigment network (asymmetrically located and disordered)[5,16]   22 95     1.8
4. Blotch (off-centered)[13,14]           4.1-4.9
5. Atypical dots and/or globules[3,6,7,13,14] 24 25-40 74-92 13-79 61-86 2.9-4.8
6. Regression structures
Scar-like areas[1,3,5,8] 23 17-36 93-99 89 70 4.4-18.3
Peppering[3,17] 22 85 93-99 27 99 3.5
Scar-like areas and peppering[3,5,6,13,14]   22-42 93-99 78   3.9-7.8
Blue-white veil overlying macular areas and scar-like areas and peppering[11,12,18]       44 91Δ 3.1-8.7
7. Blue-white veil overlying raised areas[1,3,5,6,8,9,13,14] 11 17-75 86-99 52-73 55-70 2.5-13
8. Atypical vascular structures[3,6,10,13,14,19-21] 63 9.4 54-96 69 53 1.5-7.4
Dotted + serpentine[3] 30   85     2.3
Serpentine vessels[3,22] 34   80 68   2.1
Polymorphous vessels[3,22]       68   2.1
Milky-red areas[3,22] 51   71

77.8

   2.5
Red globules[3,22] 21   88   2.0
9. Crystalline structures (also known as Chrysalis and shiny white streaks)[23]           9.7
10. Brown peripheral structureless areas[3,6] 19 63 93-96 94 73 2.9-28
* The odds ratios for the diagnosis of melanoma shown in the table are statistically significant since the 95% confidence intervals do not include the unit.
¶ When involving >50 percent of the lesion.
Δ When involving <50 percent of the lesion.
References:
  1. Soyer HP, Smolle J, Leitinger G, et al. Diagnostic reliability of dermoscopic criteria for detecting malignant melanoma. Dermatol 1995; 190:25.
  2. Marghoob AA, Korzenko AJ, Changchien L, et al. The beauty and the beast sign in dermoscopy. Dermatol Surg 2007; 33:1388.
  3. Menzies SW, Kreusch J, Byth K, et al. Dermoscopic evaluation of amelanotic and hypomelanotic melanoma . Arch Dermatol 2008; 144:1120.
  4. Stoecker WV, Stolz W. Dermoscopy and the diagnostic challenge of amelanotic and hypomelanotic melanoma. Arch Dermatol 2008; 144:1207.
  5. Menzies SW, Ingvar C, McCarthy WH. A sensitivity and specificity analysis of the surface microscopy features of invasive melanoma. Melanoma Res 1996; 6:55.
  6. Annessi G, Bono R, Sampogna F, et al. Sensitivity, specificity, and diagnostic accuracy of three dermoscopic algorithmic methods in the diagnosis of doubtful melanocytic lesions: the importance of light brown structureless areas in differentiating atypical melanocytic nevi from thin melanomas. J Am Acad Dermatol 2007; 56:759.
  7. Haenssle HA, Korpas B, Hansen-Hagge C, et al. Seven-point checklist for dermatoscopy: performance during 10 years of prospective surveillance of patients at increased melanoma risk. J Am Acad Dermatol 2010; 62:785.
  8. Salopek TG, Kopf AW, Stefanato CM, et al. Differentiation of atypical moles (dysplastic nevi) from early melanomas by dermoscopy. Dermatol Clin 2001; 19:337.
  9. Kenet RO, Kang S, Kenet BJ, et al. Clinical diagnosis of pigmented lesions using digital epiluminescence microscopy. Grading protocol and atlas. Arch Dermatol 1993; 129:157.
  10. Pizzichetta MA, Stanganelli I, Bono R, et al. Dermoscopic features of difficult melanoma. Dermatol Surg 2007; 33:91.
  11. Soyer HP, Argenziano G, Zalaudek I, et al. Three-point checklist of dermoscopy. A new screening method for early detection of melanoma.Dermatology 2004; 208:27.
  12. Zalaudek I, Argenziano G, Soyer HP, et al. Three-point checklist of dermoscopy: an open internet study. Br J Dermatol 2006; 154:431.
  13. Argenziano G, Fabbrocini G, Carli P, et al. Epiluminescence microscopy for the diagnosis of doubtful melanocytic skin lesions. Comparison of the ABCD rule of dermatoscopy and a new 7-point checklist based on pattern analysis. Arch Dermatol 1998; 134:1563.
  14. Argenziano G, Chimenti S, Talamini R, et al. Dermoscopy of pigmented skin lesions: results of a consensus meeting via the Internet. J Am Acad Dermatol 2003; 48:679.
  15. Dal Pozzo V, Benelli C, Roscetti E. The seven features for melanoma: a new dermoscopic algorithm for the diagnosis of malignant melanoma. Eur J Dermatol 1999; 9:303.
  16. Marghoob AA. Unpublished data.
  17. Braun RP, Gaide O, Oliviero M, et al. The significance of multiple blue-grey dots (granularity) for the dermoscopic diagnosis of melanoma. Br J Dermatol 2007; 157:907.
  18. Zalaudek I, Argenziano G, Ferrara G, et al. Clinically equivocal melanocytic skin lesions with features of regression: a dermoscopic-pathological study. Br J Dermatol 2004; 150:64.
  19. Bono A, Maurichi A, Moglia D, et al. Clinical and dermatoscopic diagnosis of early amelanotic melanoma. Melanoma Res 2011; 11:491.
  20. Pizzichetta MA, Talamini R, Stanganelli I, et al. Amelanotic/hypomelanotic melanoma: Clinical and dermoscopic features. Br J Dermatol 2004; 150:1117.
  21. Puig S, Argenziano G, Zalaudek I, et al. Melanomas that failed dermoscopic detection: A combined clinicodermoscopic approach for not missing melanoma. Dermatol Surg 2007; 33:1262.
  22. Argenziano G, Zalaudek I, Corona R, et al. Vascular structures in skin tumors: a dermoscopy study. Arch Dermatol 2004; 140:1485.
  23. Balagula Y, Braun RP, Rabinovitz HS, et al. The significance of crystalline/chrysalis structures in the diagnosis of melanocytic and nonmelanocytic lesions. J Am Acad Dermatol 2011. Epub ahead of print.
Reproduced with permission from Drs. Ashfaq Marghoob and Natalia Jaimes.
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