Dermatoscopy in melanocytic lesions
Critical cutting-points of total dermatoscopic score for diagnosing melanoma
Abstract
Dermatoscopy has proved its diagnostic capacity in early stages of melanoma.
Total dermatoscopic score (TDS) is one of the most used quantification risk system.
Strategy of validation involved its application to a wide group of melanocytic lesions, including melanomas of easy diagnosis with high TDS, thus, cutting-points were of high exigency. This might have caused decrease in predictive value of negative tests (VPNN) in clinically 'suspicious' lesions (LCD) among fine melanocytic nevi with intense junction activity. The study aimed at analyzing TDS cutting-points applicable to LCD that could reduce proportion of false negative tests.
Method. Out of 2 396 melanocytic lesions, 187 were dried and studied. More than 50% was integrated by congenital or acquired melanocytic nevi, lentigos actinics and clinically evident melanomas while 92 fitted LCD melanoma, determined the study group. TDS was calculated for each LCD melanoma, following classic criteria. Diagnosis was determined for all cases by pathologic anatomy (AP), two groups were studied according to sex, age, phototype, and familial syndrome of multiple nevi and atypical nevos, or both (SNM and SNA).
Results. PA showed 63 melanocytic nevi (group A) and 29 melanomas (group B). No differences in relation to sex, age, phototype, SNM or SNA were found. Exactitude parameters were calculated using TDS values; a ROC curve helped to determine suitable cutting-points, in this study it was lower than Stolz', showing 93.1% sensibility, 85.7% specificity and 96.4% VPPN.
Discussion. Our findings showed that the proposed cutting-point achieved an excellent VPPN with no alterations at sensibility and specificity levels. More numerous and prospective studies are needed to validate this proposition.
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