OBJECTIVE: To identify dermoscopic features that aid in distinguishing small diameter melanomas (≤5 mm) from equivocal melanocytic nevi measuring ≤5 mm.
METHODS: A retrospective multicenter study was conducted to collect demographics, clinical and dermoscopic pictures of (i) histology-proven flat melanomas, measuring ≤5 mm, (ii) histology-proven but clinically/dermoscopically equivocal melanocytic nevi measuring ≤5 mm, and (iii) histology-proven flat melanomas, measuring >5 mm. An independent dermoscopic evaluation was performed. Differences in predefined dermoscopic features were assessed across the three groups.
RESULTS: A total of 103 melanomas measuring ≤5 mm were collected; 166 control lesions, comprising 85 large (>5 mm) melanomas and 81 dubious, clinically equivocal melanocytic nevi measuring ≤5 mm were included. Of the 103 mini-melanomas, only 44 were melanoma in situ. Five dermoscopic predictors of melanoma were identified for the assessment of flat, non-facial melanocytic lesions measuring ≤5 mm, namely: atypical pigment network, blue-white veil, pseudopods, peripheral radial streaks, and presence of more than one color. The latter were combined into a predictive model capable of identifying melanoma with 65% sensitivity and 86.4% specificity, at a cut-off score of 3. Among melanomas measuring ≤5 mm, presence of a blue-white veil (P = 0.0027) or negative pigment network (P = 0.0063) was associated with invasiveness.
CONCLUSIONS: A set of five dermoscopic predictors of melanoma, atypical pigment network, blue-white veil, pseudopods, peripheral radial streaks, and presence of more than one color is proposed for the assessment of flat, non-facial melanocytic lesions measuring ≤5 mm.
目的:确定有助于区分小直径黑色素瘤(≤5mm)和测量≤5mm的可疑黑素细胞痣的皮肤镜特征。
方法:进行了一项回顾性多中心研究,以收集人口统计学,(i)组织学证实的扁平黑色素瘤的临床和皮肤镜图片,测量≤5mm,(ii)组织学证实,但临床/皮肤镜检查上模棱两可的黑素细胞痣测量≤5毫米,和(iii)组织学证实的扁平黑色素瘤,测量>5毫米。进行独立的皮肤镜评估。在三组中评估预定义的皮肤镜特征的差异。
结果:共收集103个测量≤5毫米的黑素瘤;166个对照病变,包括85个大的(>5毫米)黑色素瘤和81个可疑的,包括临床上可疑的黑素细胞痣,测量≤5mm。在103例微小黑色素瘤中,只有44人是原位黑色素瘤。确定了五种黑色素瘤的皮肤镜预测因子,用于评估扁平,非面部黑素细胞病变测量≤5mm,即:非典型色素网络,蓝白色的面纱,伪足,周边径向条纹,存在不止一种颜色。后者被组合到一个预测模型中,能够以65%的灵敏度和86.4%的特异性识别黑色素瘤。截止得分为3分。在测量≤5mm的黑色素瘤中,蓝白色面纱(P=0.0027)或阴性色素网络(P=0.0063)的存在与侵袭性相关。
结论:一组黑色素瘤的五种皮肤镜预测因子,非典型颜料网络,蓝白色的面纱,伪足,周边径向条纹,并建议存在一种以上的颜色来评估平面,非面部黑素细胞病变测量≤5毫米。