International Dermoscopy Society (IDS) criteria for skin tumors: validation for skin of color through a Delphi expert consensus by the “Imaging in Skin of Color” IDS Task Force

Abstract

Introduction: A structured set of eight basic dermoscopic parameters (lines, clods, dots, circles, pseudopods, structureless, else, and vessels) including a total of 77 variables with corresponding descriptive and metaphoric vocabulary has been released for evaluation of skin tumors by the International Dermoscopy Society (IDS). Objectives: To validate the aforementioned criteria for the use in darker phototypes (phototypes IV-VI) via an expert consensus. Methods: The two-round “Delphi method” was adopted, with an iterative process including two rounds of email questionnaires. Potential panelists were asked to take part to the procedure via email on the basis of their expertise on dermoscopy of skin tumors in dark phototypes. Results: A total of 17 participants were involved. All the original variables of the eight basic parameters reached agreement during the first round, except for “pink small clods” (“milky red globules”) and “structureless pink zone” (“milky red areas”). Moreover, during the first round, panelists proposed a change of three existing items and the introduction of four new items, i.e., “black, small clods” (“black globules”), “follicular plugs”, “erosions/ulcerations”, and “white color around vessels” (“perivascular white halo”). All such proposals achieved agreement, thus being included in the final list, for a total of 79 items. There was consistency between descriptive and metaphoric approach in terms of scoring. Conclusions: Albeit most of the original items were considered applicable even for skin of color, there are some points of differences that physicians need to know. No significant preference was found between descriptive and metaphoric terminology among panelists.

Dermoscopy Use in Africa: Determinants and Challenges

“…Various nationwide surveys and pan-continental studies from other continents reported dermoscopy use ranging from 56.9 % to 98% [ 5 , 9 – 11 , 23 – 26 , 28 – 31 ]. Despite widespread awareness of its dermatological utility, dermoscopy use was predictably lower (50%) than in Western societies This observation aligns with the evolving role of dermoscopy in diagnosing skin conditions in individuals with darker skin phototypes, a population largely represented in Africa [ 21 , 22 , 32 , 33 ]. Historically, dermoscopy had been used exclusively for distinguishing neoplastic lesions from pigmented and non-pigmented benign lesions in lighter skin phototypes [ 34 ].…”

“…There are however relatively few studies on dermoscopic features of skin lesions in the darker skin phenotypes [ 15 , 16 , 20 ]. Until recently, there has not been standardized terminologies for the dermoscopy of skin lesions in skin of color [ 21 , 22 ]. However, in order to demonstrate the diagnostic utility of dermoscopy and formulate useful diagnostic criteria in darker skin types, many more studies from this population are needed.…”

Dermoscopy of Cutaneous Neoplasms in Skin of Color – A Systematic Review by the International Dermoscopy Society “Imaging in Skin of Color” Task Force

“…Moreover, available information for some tumors concerns only some tones of “dark skin” spectrum (especially phototype IV). Nevertheless, the possible correspondence between histopathological changes of cutaneous tumors and dermoscopic findings even in skin of color makes oncological dermoscopy a potential useful aid in dark phototypes too [ 8 ]. Future comprehensive studies using a homogeneous/standardized approach will help in this regard.…”

Race-Specific and Skin of Color Dermatoscopic Characteristics of Skin Cancer: A Literature Review

“…Dermatoscopy is a precious tool for dermatologists, enabling an assessment of skin lesions based on patterns, structures, signs and colors and significantly facilitating the clinicaldiagnosis. In SoC, different color backgrounds and patterns typical of darker phototypes maybe alter the dermoscopic aspect, as compared to white skin [ 4 ]. The combination between ‘skin of colour” and ‘dermatoscopy” Pubmed search results in 680 articles with limited research in the dermatoscopy of skin cancer in SoC patients.…”