Accuracy of dermoscopy structures and patterns clarified in melanoma detection

Photo by Juliana Casagrande Tavoloni Braga et al, via Wikimedia Commons

Findings from a systematic review of the accuracy of the individual structures and patterns used in dermoscopy for melanoma detection support the diagnostic importance of these structures. The findings also further support the importance of the overall pattern and may suggest a hierarchy of significance.

These are the conclusions of a paper published online ahead of print in JAMA Dermatology (Aug. 4, 2021).

“Dermoscopy increases the diagnostic accuracy for melanoma. However, the accuracy of individual structures and patterns used in melanoma detection has not been systematically evaluated,” the authors write.

For their evaluation, the researchers searched Ovid Medline, Embase, Cochrane CENTRAL, Scopus, and Web of Science for studies that examined dermoscopic structures and patterns in melanoma compared to nonmelanoma lesions.

They excluded studies with fewer than three patients, studies not written in English or Spanish, or studies that did not report structures per lesion type. They also excluded studies that only assessed nail, mucosal, acral, facial or metastatic melanomas, or melanomas on chronically sun-damaged skin.

The investigators evaluated a total of 40 studies that included 22,796 skin lesions and 5,736 melanomas.

In their analysis, the researchers evaluated diagnostic accuracy and risk (calculated as an odds ratio) of melanoma following dermoscopy for a specific list of dermoscopic structures and patterns. These included: atypical dots or globules; atypical network; blue-white veil; negative network; off-centred blotch; peripheral-tan structureless areas; atypical vessels; pseudopods; streaks; regression; shiny white structures; angulated lines; irregular pigmentation; and a multi-component pattern.

The structures and patterns with the highest odds ratios were shiny white structures, pseudopods, irregular pigmentation, blue-white veil, and peppering. The structures with the highest specificity were pseudopods, shiny white structures, peppering and streaks.

For features, those with the highest sensitivity were irregular pigmentation, blue-white veil, atypical network and a multi-component pattern.