Seven-point checklist reasonably effective for diagnosing melanoma
MedWire News: The seven-point checklist algorithm for detecting melanoma is relatively effective for predicting melanoma, but use of complementary information increases accuracy, show study results.
Holger Haenssle (Georg August University Göttingen, Germany) and colleagues assessed the diagnostic performance of the dermatoscopic seven-point checklist for diagnosing melanoma.
The seven criteria were defined as: gray-blue areas, atypical vascular pattern, atypical pigment network, irregular diffuse pigmentation, regression pattern, radial streaming or streaks, and irregular dots and globules. Melanoma was diagnosed or strongly suspected if a patient had a score of three points or more.
The researchers screened 688 patients who were at increased risk for melanoma using naked eye examination, the seven-point checklist, and digital dermatoscopy at regular intervals over a 10-year period.
In total, 127 melanomas were detected over the 10-year follow-up period, with a mean Breslow thickness of invasive melanomas of 0.57 mm.
In total, 79 melanomas were scored as having three points or more on the seven-point checklist, resulting in a sensitivity score of 62%. The other 48 melanomas scored less than three points, but were excised due to use of complementary information such as lesional history, and dynamic changes detected using digital dermatoscopy.
Specificity of the seven-point checklist was better at 97%.
The points most strongly associated with increased relative risk for melanoma were regression patterns, atypical vascular patterns, and radial streaming, which increased relative risk for melanoma 3.26-, 3.04-, and 2.91-fold, respectively.
Of note, melanomas that were thicker than 0.50 mm had significantly more regression and atypical vascular patterns than thinner lesions.
“The differentiation between atypical benign nevi and early melanoma is a considerable challenge for the clinician,” write the authors in the Journal of the American Academy of Dermatology.
They conclude that “the seven-point checklist for dermatoscopy was less sensitive but highly specific in this prospective surveillance study of patients at high risk in comparison with previous retrospective analyses.”
“However, complementary information (eg, derived from anamnestic data or digital dermatoscopy) helped to identify 48 (38%) additional melanomas and, therefore, clearly increased the sensitivity.”
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By Helen Albert