Abstract
Simple SummaryThe early detection of melanoma determines the recovery of the patient. Dermoscopy, which is one of the diagnostic tools for pigmented lesions, is characterized by high sensitivity and specificity, giving the clinician the possibility to detect the presence of abnormal structures before their clinical presentation. There are a small number of dermoscopic analyses of pigmented lesions of less than 6 mm in diameter in the published literature. The authors attempted to identify characteristic dermoscopic structures typical for melanomas of less than 5 mm in diameter in comparison with a group of melanomas exceeding this dimension at an identical clinical stage. It was found that dermoscopy in the secondary prevention of micromelanomas (appearing mainly as brown lesions) revealed the presence of dotted or polymorphous vessels, with architectural disorder in half of cases. Moreover, spitzoid, multicomponent asymmetric or nonmelanoma-specific patterns prevailed. Knowledge of these dermoscopic features brings the clinician closer to an early diagnosis of melanoma with a diameter of 5 mm or less.Objective: The aim of the study was to verify two hypotheses. The first concerned the possibility of diagnostic dermoscopic differentiation between cutaneous melanomas of the histopathological category in situ (pTis) and thin melanomas (pT1a) in terms of their diameter. The second assessed the diagnostic feasibility of two dermoscopic algorithms aiming to detect ≤ 5.0 mm-sized melanomas histopathologically confirmed as pTis and pT1a. Methods: Dermoscopic images of consecutive cases of histopathologically confirmed melanomas were evaluated by three independent investigators for the presence of the predefined criteria. The melanomas were subdivided according to their diameter into small melanomas, so-called micromelanomas (microM)—sized ≤ 5.0 mm and >5.0 mm, according to published definitions of small melanocytic lesions. The Triage Amalgamated Dermoscopic Algorithm (TADA) and the revisited 7-point checklist of dermoscopy (7-point) algorithm were chosen for the diagnostic feasibility. Odds ratios and corresponding 95% confidence limits (CL) were calculated using the logistic regression adjusted for age for the melanoma-specific dermoscopic structures, the dermoscopic patterns and the diagnostic feasibility of the 7-point checklist and TADA algorithms. The p-values of the results were corrected using the Bonferroni method. Results: In total, 106 patients with 109 melanomas, 50 sized ≤ 5.0 mm and 59 exceeding the diameter of 5.0 mm, were retrospectively analyzed. The prevalent general pattern of microM was the spitzoid one (48% vs. 11.86%, p = 0.0013). Furthermore, 40% of microM vs. 6.78% melanomas sized > 5.0 mm (p = 0.0023) did not present melanoma-specific patterns. The asymmetric multicomponent pattern was present in 64.41% melanomas sized > 5.0 mm and in 26.00% microM (p = 0.0034). The asymmetry of structures or colors was detected in 56% microM vs. 89.83% (p = 0.0020) and 56% microM and 94.92% (p = 0.000034) melanoma sized > 5.0 mm, respectively. The differences in frequency of the detected dermoscopic structures specific to melanomas revealed that microM are almost deprived of negative networks (p = 0.04), shiny white structures (p = 0.0027) and regression features (p = 0.00003). Neither prominent skin markings nor angulated lines were found in the entire study group. Out of the vascular structures, microM presented only dotted (32%) or polymorphous (28%) vessels, although more rarely than melanomas sized > 5.0 mm (66.1% p = 0.017 and 49% p > 0.05, respectively). The diagnostic feasibility revealed a score ≥ 3 of the 7-point algorithm (indicative for malignancy) in 60% microM and 98.31% melanomas sized > 5.0 mm (p = 0.000006). The TADA algorithm revealed melanoma-specific patterns in 64% microM and 96.61% > 5.0 mm-sized melanomas (p = 0.00006) and melanoma-specific structures in 72% and 91.53% (p > 0.05), respectively. Conclusion: In the dermoscopy, 40% of micromelanomas histopathologically staged as pTis and pT1a did not reveal melanoma-specific patterns. Among the general melanocytic patterns, the spitzoid one was the most frequently found in melanomas sized ≤ 5.0 mm. The 7-point checklist and TADA dermoscopic algorithms were helpful in the identification of the majority of melanomas sized ≤ 5.0 mm.
Highlights
In recent decades, dermoscopy has proved to be irreplaceable in the noninvasive diagnosis of melanoma, as well as being established for the secondary prevention of skin malignant neoplasms [1]
All the subjects complied with the inclusion criteria: 48 patients diagnosed with 50 micromelanomas and patients diagnosed with > 5 mm-sized melanomas assigned to the comparative group
The diagnostic feasibility of the revised 7-point checklist in our study revealed a sensitivity of 60% and 98.31% in the micromelanoma group and the >5 mm-sized melanomas, respectively (p < 0.000001, ap = 0.000006) (Table 5)
Summary
Dermoscopy has proved to be irreplaceable in the noninvasive diagnosis of melanoma, as well as being established for the secondary prevention of skin malignant neoplasms [1]. The results regarding the diagnostic frequency of dermoscopic structures are difficult to compare, due to differences in the number of selected dermoscopic structures, chosen comparators and different ratios of in situ to invasive melanomas (pT1, >pT1) included. Studies conducted by Carli et al, 2003, Friedman et al, 2008, Abbasi et al, 2008, Pupelli et al, 2013, Drugge et al, 2018 and Campos-do-Carmo et al., 2021 chose melanocytic lesions as the comparator group [7,10,11,13,18,20]. The remaining studies chose different types of melanomas as the comparator group [3,6,14,15,17]. The differences concerned the ratio of in situ and invasive melanomas (Pizzichetta et al, 2001; Helsing et al, 2004; Seidenari et al, 2014; Emiroglu et al, 2014) or clinical presentation–difficult-todiagnose melanoma versus clinically evident melanoma (Dika et al, 2017) [3,6,14,15,17]
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