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A Simplified Dermoscopic Algorithm for Melanoma Diagnosis
TAKE-HOME MESSAGE
- In this retrospective study that aimed to develop a new dermoscopy algorithm for the diagnosis of melanoma, 1120 digital microscopy images of atypical melanocytic lesions with histologic confirmation were examined by 4 blinded dermatologists. A PASS score of 3 or more (scores ranging from 0 to 4), based on polychromia, asymmetry, and melanoma-specific structures, demonstrated high diagnostic accuracy (88.4%).
- The authors suggest that PASS should be considered as an alternative to current melanoma dermoscopy algorithms and that it may be simpler to use and more efficient in daily practice.
abstract
This abstract is available on the publisher's site.
Access this abstract nowINTRODUCTION
Dermoscopic algorithms for melanoma diagnosis could be time-expending, and their reliability in daily practice lower than expected.
OBJECTIVE
To propose a simplified dermoscopic algorithm for melanoma diagnosis.
MATERIAL AND METHODS
A multicenter retrospective analysis of 1,120 dermoscopic images of atypical melanocytic tumors (320 melanomas and 800 non-melanomas) was performed. An algorithm based on polychromia, asymmetry in colors or structures, and some melanoma-specific structures was designed. Univariate and multivariate logistic regression analysis was calculated to estimate the coefficients of each potential predictor for melanoma diagnosis. A score was developed based on the dermoscopic evaluations performed by four experts blinded to histological diagnosis.
RESULTS
Most melanomas had ≥3 colors (280; 84.5%), asymmetry in colors or structures (289; 90.3%), and at least one melanoma-specific structure (316; 98.7%). PASS score ≥3 had a 91.9% sensibility, 87% specificity, and 88.4% diagnostic accuracy for melanoma. PASS algorithm showed an area under the curve (AUC) of 0.947 (95% CI 0.935-0.959).
LIMITATIONS
This study was retrospective. A comparison between the performances of different dermoscopic algorithms is difficult because of their designs.
CONCLUSION
PASS algorithm showed a very good diagnostic accuracy, independently of the observers' experience, and it seems easier to perform than previous dermoscopic algorithms.
Additional Info
Do not PASS any melanoma without diagnosis: a new simplified dermoscopic algorithm
Int. J. Dermatol 2023 Jan 20;[EPub Ahead of Print], JA Avilés-Izquierdo, P García-Piqueras, C Ciudad-Blanco, B Lozano-Masdemont, P Lázaro-Ochaita, JM Bellón-Cano, E Rodríguez-LombaFrom MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.
Dermoscopy has opened up new clinical morphological scenarios, which have led to the creation of a new terminology and the development of numerous classification systems, especially in the setting of melanocytic proliferations. From the 1989 Hamburg Consensus Conference to the present, a plethora of terms and variables has been reported.1-3 The lack of unambiguous classification and standardized criteria, encounter with ambiguous quantitative terms and imprecise qualitative criteria, and absence of clear information to define the pattern threshold can lead to uncertainty and confusion in practical application. From a theoretical point of view, the proliferation of dermoscopic variables and relative patterns is imprudent. By definition, the reproducibility of clinical evaluations is inversely correlated with the number of variables and their modalities of presentation. In other branches of medicine, the validation of classification systems has imposed a process of simplification. For these reasons, the development of simplified dermoscopic analysis rules has been recommended in clinical practice, and several algorithms have been published.2,3
The proposed simplified dermoscopic algorithm PASS for melanoma diagnosis seems simple and friendly, based on few reproducible variables such as polychrome, asymmetry of colors and structures, and some melanoma-specific structures. The PASS algorithm in this retrospective study is associated with a good inter-observer preliminary agreement such as diagnostic accuracy and easy application in daily clinical practice. Limitations such as the need for prospective and comparisons studies have been highlighted.
References