Dermoscopic predictors of melanoma in small diameter melanocytic lesions (mini‐melanoma): a retrospective multicentric study of 269 cases

Abstract

Background Incidence of cutaneous melanoma is steadily growing, and its early recognition is of paramount importance. Small, pigmented lesions often represent a challenge for the clinician, as predictors of melanoma have not yet been uniquely identified in this setting. Objectives To identify dermoscopic features that aid in distinguishing small diameter melanomas (≤5 mm) from equivocal melanocytic nevi measuring ≤5 mm. Methods A retrospective multicenter study was conducted to collect demographics, clinical and dermoscopic pictures of (i) histology‐proven flat melanomas, measuring ≤5 mm, (ii) histology‐proven but clinically/dermoscopically equivocal melanocytic nevi measuring ≤5 mm, and (iii) histology‐proven flat melanomas, measuring >5 mm. An independent dermoscopic evaluation was performed. Differences in predefined dermoscopic features were assessed across the three groups. Results A total of 103 melanomas measuring ≤5 mm were collected; 166 control lesions, comprising 85 large (>5 mm) melanomas and 81 dubious, clinically equivocal melanocytic nevi measuring ≤5 mm were included. Of the 103 mini‐melanomas, only 44 were melanoma in situ. Five dermoscopic predictors of melanoma were identified for the assessment of flat, non‐facial melanocytic lesions measuring ≤5 mm, namely: atypical pigment network, blue‐white veil, pseudopods, peripheral radial streaks, and presence of more than one color. The latter were combined into a predictive model capable of identifying melanoma with 65% sensitivity and 86.4% specificity, at a cut‐off score of 3. Among melanomas measuring ≤5 mm, presence of a blue‐white veil (P = 0.0027) or negative pigment network (P = 0.0063) was associated with invasiveness. Conclusion A set of five dermoscopic predictors of melanoma, atypical pigment network, blue‐white veil, pseudopods, peripheral radial streaks, and presence of more than one color is proposed for the assessment of flat, non‐facial melanocytic lesions measuring ≤5 mm.

Exploring Small-Diameter Melanomas: A Retrospective Study on Clinical and Dermoscopic Features

“…These dermoscopic features play a significant role in the evaluation of SDMs. Interestingly, Nazzaro et al [ 14 ] observed atypical vessels exclusively in invasive melanomas with a diameter of ≤5 mm, although the association did not achieve statistical significance. Similarly, Regio Pereira et al [ 10 ] reported an association between atypical vascular patterns, macular blue-whitish areas, and shiny white structures with invasive small-diameter melanomas.…”

“…In a recent multicenter retrospective study [ 14 ], comprising 269 cases, including 103 SDMs (≤5 mm, flat, non-facial), 81 common melanocytic nevi (≤5 mm), and 85 control large (>5 mm) melanomas, demographics, clinical, and dermoscopic features were evaluated. The study found that SDMs were associated with a younger age at diagnosis and a preference for upper limbs.…”

“…In some cases, changes along clinical and dermoscopic surveillance may be the only feature suggesting malignancy in these small lesions [ 10 ]. Dermoscopic features and reproducibility of dermoscopy algorithms for SDM have been sparsely addressed in the existing literature, with only a limited number of publications focusing on the characterization of these lesions [ 3 , 4 , 5 , 11 , 12 , 13 , 14 ].…”

Clinical and Dermoscopic Findings of Nevi after Photoepilation: A Review

“…In the study of Nazzaro et al, the blue-white veil was a dermoscopic feature associated with the diagnosis of mini-melanomas with diameters ≤5 mm compared to clinically equivocal melanocytic nevi with diameters ≤5 mm. Also, they reported that the blue-white veil was detected more frequently in invasive mini-melanomas compared to in situ mini-melanomas [ 38 ]. In addition, reflectance confocal microscopy has recognized plump cells corresponding to melanophages and inflammatory infiltrates in histology within the blue areas recognized by dermoscopy [ 36 ].…”

The effects of the COVID-19 pandemic on the diagnosis and prognosis of melanoma 2 years after the pandemic in two Romanian counties

“…While most of the patients get a small scar after a wide excision, with almost zero morbidity, the negative emotional and economic effects of overdiagnosis support the efforts to reduce it ( 12 , 13 ). Nazzaro et al proposed five dermoscopic predictors of small diameter melanoma to decrease the rate of overdiagnosis and the unnecessary biopsies, but further research on larger datasets is needed to validate the results ( 14 ).…”