The impact of anatomical location and sun exposure on the dermoscopic recognition of atypical nevi and early melanomas: usefulness of an integrated clinical‐dermoscopic method (iDScore)

Abstract

Background The anatomical location of atypical melanocytic skin lesion (aMSL) was never combined into an algorithm for discriminating early melanomas (EM) from atypical nevi (AN). Aims To investigate the impact of body location on the intuitive diagnosis performed in teledermoscopy by dermatologists of different skill levels. A further aim was to evaluate how the integration of the body location could improve an algorithm‐aided diagnosis. Methods We retrospectively collected 980 standardized dermoscopic images of aMSL cases (663 AN, 317 EM): data on the anatomical location were collected according to 15 body sites classified into 4 macro‐areas of chronically/frequently/seldom/rarely exposure. Through a teledermatology web platform, 111 variously skilled dermoscopists performed either the intuitive diagnosis and 3 algorithm‐assisted diagnostic tests (i.e. iDScore, 7‐point checklist, ABCD rule) on each case, for a total of 3330 examinations. Results In the rarely photoexposed area (side, bottom, abdomen), AN were the most tricky (i.e. highest quote of false positives), due to a frequent recognition of dermoscopic features usually considered as suggestive for melanoma in these lesions; the EM at these sites received the highest quote of false negatives, being generally interpreted as ‘featureless’ according to these traditional parameters, that were more frequently displayed on the chronically photoexposed area. In rarely and seldom photoexposed area, intuitive diagnosis fails to achieve adequate accuracy for all aMSLs, as the ABCD rule and the 7‐point checklist; by applying the iDScore algorithm the diagnostic performance was increased by 15% in young and 17% in experts. Conclusions The body location of an aMSL can affect the quality of intuitive dermoscopic diagnosis, especially in sun‐protected areas. Accuracy can be improved by using the iDScore algorithm that assigns a different partial score of each body site.

Dermoscopy of atypical pigmented lesions of the face: Variation according to facial areas

“…Summarizing, the present findings demonstrate that the traditionally recognized dermoscopic patterns are generally poorly specific of malignancy/benignity when dealing with difficult equivocal aPFLs and that a site specific variation can be due to both skin anatomy (e.g. nose) and photoexposure entity (forehead, cheek) 4,8,10 . The nasal area turned out to be particularly challenging.…”

“…nose) and photoexposure entity (forehead, cheek). 4,8,10 The nasal area turned out to be particularly challenging. In conclusion, dermatologists should pay particular attention to aPFLs, especially in male patients aged > 69 years, lesions located on the forehead area displaying the obliterated follicular openings pattern, as well as an aPFL at any facial area with pigment rhomboids and a diameter > 11 mm, especially in a male.…”

A risk‐scoring model for the differential diagnosis of lentigo maligna and other atypical pigmented facial lesions of the face: The facial iDScore

“…These tools are still mainly limited to research settings. Most dermoscopists find it hard to trust a numerical output or have trouble translating the number into a practical management decision 45,46 . In this scenario, a simple Bayesian model based on scoring classifiers, such as the facial iDScore model introduced here, can be proposed as a rapid and easy tool for variously experienced dermatologists following the clinical dermoscopic examination of aPFLs.…”

Multiple Primary Melanoma: A Five-Year Prospective Single-Center Follow-Up Study of Two MC1R R/R Genotype Carriers

“…High-risk patients (i.e., patients with a personal or familial history of melanoma, extensive photodamage, high nevus count, nevi of variable colors and/or multiple sizes) may be carriers of mutations in either moderate/low or high melanoma susceptibility genes. The opportune acknowledgment of PM and MPM thru clinical exams defy clinicians, because naked-eye recognition of early melanomas, that mimic moles, can be difficult, even more so when patients have multiple nevi, making excision not feasible or desirable [6,16,42,43]. The advent of dermoscopy, TBSP, DD, SDDI and RCM has been an enlightening path for dermatologists dedicated to skin cancer diagnosis, treatment, and surveillance.…”