Dermoscopy of Small Diameter Melanomas with the Diagnostic Feasibility of Selected Algorithms—A Clinical Retrospective Multicenter Study

Abstract

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.

Clinical and Dermatoscopic Signs of Micromelanoma - A Review of the Literature

“…The most used diagnostic dermatoscopic algorithm was the 7-point checklist. The diagnostic accuracy of the dermatoscopic algorithms was in the range of 48.2 -65.9% [10,12].…”

“…In the literature the dermatoscopy was the most commonly used diagnostic method [5,6,[9][10][11][12][13][14][15][16]19], which included polarized light [4,9,12,13,16] and nonpolarized light dermatoscopy [4,6,[11][12][13][14], digital dermatoscopy with polarized light -Fotofinder HD 800 [6], Medicam 1000 [10], Mole Max [10,13] and total body photography [20]. The diagnostic dermatoscopic algorithms used in the reviewed studies and cases were Chaos and clues [16], TADA (Triage Amalgamated Dermatoscopic Algorithm) [10], 7-point checklist of dermatoscopy [3,[10][11][12], 3-point checklist of dermatoscopy [12], Menzies method [11,12], ABCD algorithm [3,15] and its total dermatoscopy score [3,13], and revised pattern analysis [12].…”

“…Micromelanomas are more commonly diagnosed in women [3,4,6,9,10,[12][13][14][15][16], as 43 -81.8% of patients were women. Patients mostly are in the age group of 40 -59 years [3][4][5][10][11][12][13][14][15].…”

“…In scientific literature identified risk factors for micromelanoma are melanoma in patients' history [6,[9][10][11][12] or patients' family history [3,10,12], patient with a dysplastic naevus syndrome [10,12], the female gender [3,4,6,9,10,[12][13][14][15][16], age of 40 -59 years [3][4][5][10][11][12][13][14][15] and II skin phototype by Fitzpatrick [5,10,16].…”

“…As for micromelanomas they can present as in situ or an invasive lesion [4, 5, 7, 9-16, 19, 20]. Subtypes of invasive melanoma have been traditionally distinguished into four major clinicpathological subtypes: superficial spreading melanoma (SSM) (41%), nodular melanoma (NM) (16%), lentigo maligna melanoma (LMM) (2.7%-14%) and acral lentiginous melanoma (ALM) (1%-5% in non-Hispanic White population and higher rates in Asian or African American population) [8], who are also relevant for micromelanomas, as in several scientific publications [7,9,10,12,13,19] there have been diagnosed invasive micromelanomas with a subtype of SSM [7,10,12,13], LMM [9,10,12,19], NM [12].…”