Geometric border as a marker for melanoma diagnosis: Study of 200 consecutive melanocytic lesions (original) (raw)

Geometric Cutaneous Melanoma: A Helpful Clinical Sign of Malignancy?

Dermatologic Surgery, 2003

BACKGROUND. Malignant melanomas change shape in a random pattern, with ovoid, crescentic, or nodular shapes seen most frequently. We have observed a number of malignant melanomas that have presented with a geometric, angular shape and have noted that pigmented lesions with this configuration are often found to be malignant. We present 20 patients with malignant melanoma whose lesion displayed a geometric, angular shape. METHODS. Before excision for formal histopathology, all lesions were scored using the seven-point checklist and ABCDE systems and were divided into low-risk or significant risk of melanoma. RESULTS. Five different geometric shapes were observed. Depending on the scoring system employed, 20% to 40% of the geometric melanomas were considered to be of low risk of malignancy.

Management Rules to Detect Melanoma

Dermatology, 2013

Most melanomas are easy to be diagnosed clinically and dermoscopically. The question remains open concerning the correct strategies to detect those melanomas that look morphologically inconspicuous from a clinical and/or dermoscopic point of view. In our estimation, when morphology is not enough to recognize melanoma, one has to use specific management strategies. Herein we summarize the following 7 simple and practical rules that outline the need for a more general approach integrating clinical information with dermoscopic examination: (1) Look basically at all lesions.

Clinical Clues to Avoid Missing Melanoma When Morphology Is Not Enough

Dermatology Practical & Conceptual

This editorial on difficult-to-diagnose melanomas will discuss the following points: 1. Melanoma can be missed not only when the lesion is lacking specific morphologic clues, but also when the lesion is localized on covered areas and the patient is not undressed by the clinician. 2. When morphologic criteria to diagnose melanoma are lacking, there are 5 particularly relevant clinical clues to be considered, in order to avoid the risk of leaving a melanoma untreated. 3. Once the lesion is excised, melanoma could still be missed if a careful clinico-pathologic correlation is not carried out. No One Should Die of Melanoma "No one should die of melanoma". The reason why AB Ackerman wrote such a catchy statement back in 1985 [1] is related to the fact that, at least theoretically, all melanomas can be recognized and treated at an early stage because of their location on the skin, which is easy to be examined. Unfortunately, many people still die of melanoma, and this is due to at least 3 main actors. The First Actor is Melanoma Itself There is a small number of tumors that are typified by a highly aggressive behavior. This type of melanomas, namely nodular melanomas, develop fast and become thick enough to acquire the potential to metastasize in few months only [2,3]. Nodular melanomas are difficult to excise before they become dangerous, thus very little could be done to change this dramatic scenario.

Clinical ABCDE rule for early melanoma detection

European Journal of Dermatology, 2021

Background: The ABCDE rule systematizes warning signs for malignant melanoma (MM). Objectives: To evaluate whether the ABCDE signs are associated with early detection of MM. Materials & Methods: Based on a retrospective study over 11.5 years, we assessed whether ABCDE signs are associated with early diagnosis of MM. Results: In total, 144 MM were included; 52 (36.1%) in situ and 92 (63.9%) invasive lesions. For 23.6%, the MM were first suspected by an individual other than a dermatologist. The "E sign" was significantly less frequent among in situ lesions (32.7% versus 50.0%; p = 0.044). Based on adjusted analyses, the probability of MM being first suspected by a non-dermatologist consistently increased with the number of ABCDE signs of the lesion, ranging from 8% for a neoplasm with no ABCDE signs to 32% for a lesion with five signs (OR = 1.6; 95% CI: 1.2-2.2; p = 0.004). Conclusion: A higher number of ABCDE signs were associated with a greater chance of MM being first suspected by a non-dermatologist, but not in situ MM diagnosis. Relying on the ABCDE rule alone might result in missing early MM lesions.

Blue-black rule: a simple dermoscopic clue to recognize pigmented nodular melanoma

British Journal of Dermatology, 2011

Background Dermoscopy improves melanoma recognition, but most criteria were described in the context of superficial spreading melanoma. Objectives To test whether pigmented nodular melanoma could be recognized dermoscopically by the presence of a combination of blue and black colour within the lesion. Methods Dermoscopic images of histopathologically diagnosed pigmented nodular tumours with no (or only minimal) flat component were evaluated for the presence of standard melanoma criteria and for the presence of a new feature named blue-black (BB) colour. Sensitivity, specificity, positive predictive value and negative predictive value were calculated for standard criteria and BB feature in relation to the diagnosis of melanoma and to diagnosis of malignancy. Results Of 283 lesions, 160 were malignant, including 78 (27AE6%) melanomas, and 123 were benign. The BB feature and the standard criteria had 78AE2% and 43AE6% sensitivity for melanoma, respectively, whereas a combined method based on the presence of either the BB feature or one (or more) of the standard criteria reached 84AE6% sensitivity, with 80AE5% specificity and 93AE2% negative predictive value. Sensitivity values for malignant lesions were only 24AE4%, 56AE9% and 60% for standard criteria, BB feature and the combined method, respectively. However, the combined method gave 91AE9% specificity and 90AE6% positive predictive value for malignancy. Conclusions Using a method based on the BB feature or one of the standard melanoma criteria, only 9AE4% of positive pigmented nodular lesions were found to be benign and only 6AE8% of negative lesions were found to be melanoma histopathologically.

Melanoma--clinical, dermatoscopical, and histopathological morphological characteristics

Acta dermatovenerologica Croatica : ADC, 2014

Melanoma is one of the most malignant skin tumors with constantly rising incidence worldwide, especially in fair-skinned populations. Melanoma is usually diagnosed at the average age 50, but, nowadays is also diagnosed more frequently in younger adults, and very rarely in childhood. There is no unique or specific clinical presentation of a melanoma. The clinical presentation of melanomas varies depending on the anatomic localization and the type of growth, i.e., the histopathological type of the cancer. There are four major histopathological types of melanoma--superficial spreading melanoma, nodular melanoma, lentigo maligna melanoma, and acral lentiginous melanoma. Although dermatoscopy is a very useful tool in early melanoma detection, dermatoscopical features of melanomas are also variable. Therefore, experience and education in dermatoscopy is crucial in the evaluation of skin tumors. Differential diagnosis of melanomas includes a wide range of benign and malignant skin lesions,...

Limitations of Histopathologic Analysis in the Recognition of Melanoma

Archives of Dermatology, 2005

A Plea for a Combined Diagnostic Approach of Histopathologic and Dermoscopic Evaluation T HE ARTICLE PUBLISHED BY SKVARA ET AL 1 IN this issue of the ARCHIVES focuses on the limitations of dermoscopy in the diagnosis of very early and mainly featureless melanomas. The authors report that baseline dermoscopic patterns of 262 melanocytic nevi did not differ from those of 63 melanomas observed by digital dermoscopy and finally excised because of changes overtime. The authors wisely foresee that this basically featureless or "feature-poor" group of melanomas will be used by both sides in the digital dermoscopy controversy: proponents will cite them as evidence that follow-up with digital dermoscopy is necessary; opponents point to them as evidence that dermoscopy is unnecessary and that every clinically suspicious lesion must be excised. The authors acknowledge the strengths and limitations of both views, but the question remains whether dermoscopically featureless or feature-poor lesions warrant excision.

Novice identification of melanoma: not quite as straightforward as the ABCDs

Acta dermato-venereologica, 2011

The "ABCD" mnemonic to assist non-experts' diagnosis of melanoma is widely promoted; however, there are good reasons to be sceptical about public education strategies based on analytical, rule-based approaches--such as ABCD (i.e. Asymmetry, Border Irregularity, Colour Uniformity and Diameter). Evidence suggests that accurate diagnosis of skin lesions is achieved predominately through non-analytical pattern recognition (via training examples) and not by rule-based algorithms. If the ABCD are to function as a useful public education tool they must be used reliably by untrained novices, with low inter-observer and intra-diagnosis variation, but with maximal inter-diagnosis differences. The three subjective properties (the ABCs of the ABCD) were investigated experimentally: 33 laypersons scored 40 randomly selected lesions (10 lesions × 4 diagnoses: benign naevi, dysplastic naevi, melanomas, seborrhoeic keratoses) for the three properties on visual analogue scales. The res...

Blue-black rule: a simple dermoscopic clue to recognize pigmented nodular melanoma Funding sources

Background Dermoscopy improves melanoma recognition, but most criteria were described in the context of superficial spreading melanoma. Objectives To test whether pigmented nodular melanoma could be recognized dermoscopically by the presence of a combination of blue and black colour within the lesion. Methods Dermoscopic images of histopathologically diagnosed pigmented nodular tumours with no (or only minimal) flat component were evaluated for the presence of standard melanoma criteria and for the presence of a new feature named blue-black (BB) colour. Sensitivity, specificity, positive predictive value and negative predictive value were calculated for standard criteria and BB feature in relation to the diagnosis of melanoma and to diagnosis of malignancy. Results Of 283 lesions, 160 were malignant, including 78 (27AE6%) melanomas, and 123 were benign. The BB feature and the standard criteria had 78AE2% and 43AE6% sensitivity for melanoma, respectively, whereas a combined method based on the presence of either the BB feature or one (or more) of the standard criteria reached 84AE6% sensitivity, with 80AE5% specificity and 93AE2% negative predictive value. Sensitivity values for malignant lesions were only 24AE4%, 56AE9% and 60% for standard criteria, BB feature and the combined method, respectively. However , the combined method gave 91AE9% specificity and 90AE6% positive predictive value for malignancy. Conclusions Using a method based on the BB feature or one of the standard mela-noma criteria, only 9AE4% of positive pigmented nodular lesions were found to be benign and only 6AE8% of negative lesions were found to be melanoma histopatho-logically.