Dermoscopic patterns of melanoma metastases: interobserver consistency and accuracy for metastasis recognition

Abstract

Background Cutaneous metastases of malignant melanoma (CMMM) can be confused with other skin lesions. Dermoscopy could be helpful in the differential diagnosis. Objective To describe distinctive dermoscopic patterns that are reproducible and accurate in the identification of CMMM Methods A retrospective study of 146 dermoscopic images of CMMM from 42 patients attending a Melanoma Unit between 2002 and 2009 was performed. Firstly, two investigators established six dermoscopic patterns for CMMM. The correlation of 73 dermoscopic images with their distinctive patterns was assessed by four independent dermatologists to evaluate the reproducibility in the identification of the patterns. Finally, 163 dermoscopic images, including CMMM and non-metastatic lesions, were evaluated by the same four dermatologists to calculate the accuracy of the patterns in the recognition of CMMM. Results Five CMMM dermoscopic patterns had a good inter-observer agreement (blue nevus-like, nevus-like, angioma like, vascular and unspecific). When CMMM were classified according to these patterns, correlation between the investigators and the four dermatologists ranged from κ = 0.56 to 0.7. 71 CMMM, 16 angiomas, 22 blue nevus, 15 malignant melanoma, 11 seborrheic keratosis, 15 melanocytic nevus with globular pattern and 13 pink lesions with vascular pattern were evaluated according to the previously described CMMM dermoscopy patterns, showing an overall sensitivity of 68% (between 54.9–76%) and a specificity of 81% (between 68.6–93.5) for the diagnosis of CMMM. Conclusion Five dermoscopic patterns of CMMM with good inter-observer agreement obtained a high sensitivity and specificity in the diagnosis of metastasis, the accuracy varying according to the experience of the observer.

Dermoscopic features and patterns of poromas: a multicentre observational case–control study conducted by the International Dermoscopy Society

“…However, in order not to miss a malignancy, any lesion with polymorphous vessels, ulceration and/or shiny white structures should be biopsied to rule out amelanotic melanoma, melanoma metastasis and SCC. [25][26][27][28] There are multiple limitations of our study. First, we did not require centralized pathology review; thus, we do not know the exact correlation of dermoscopic findings and the relative prevalence of eccrine vs. apocrine poromas and cannot exclude the possibility that intraepidermal (hidroacanthoma simplex) or dermal (dermal duct tumours) poromas, or collision tumours Poroma patterns type 1 (a-c), type 2 (d-f), type 3 (g-i) and type 4 (j-l).…”

The significance of blue color in dermatoscopy

“…Im Melanom liegt die blaue Farbe häufi g als blaue strukturlose Zone vor, die in der dermatoskopischen Terminologie klassischerweise als "blau-weißlicher Schleier" bezeichnet wird [ 11 ] . Wir konnten auch bestätigen, dass blaue Nävi und Melanom-Metastasen ununterscheidbar sein können [ 15,16 ] . Blaufärbung fi ndet sich jedoch auch bei benignen Läsionen.…”

Dermoscopy of cutaneous melanoma metastases: A color‐based pattern classification

“…Costa et al 9 described six dermoscopic patterns for CMMM based on tumor-like dermoscopic patterns with a good correlation among researchers. They obtained a sensitivity of 67.9% and specificity of 79.9%.…”

“…6 To date, only a few studies of dermoscopic characteristics of CMMM have been reported. [7][8][9][10] First, Bono et al 8 described four dermoscopic global patterns of CMMM: (i) homogenous; (ii) amelanotic; (iii) saccular and multicomponent; or (iv) polymorphic. Years later, Costa et al 9 proposed five new dermoscopic patterns of CMMM: (i) blue nevus-like; (ii) angioma-like; (iii) nevus-like; (iv) vascular; and (v) unspecific.…”