Dermoscopic and histopathologic diagnosis of equivocal melanocytic skin lesions: An interdisciplinary study on 107 cases

• Published in: Cancer 2002-09, Vol.95 (5), p.1094-1100
• Main Authors: FERRARA, Gerardo, ARGENZIANO, Giuseppe, HOFMANN-WELLENHOF, Rainer, KADDU, Steven, PICCOLO, Domenico, SCALVENZI, Massimiliano, STAIBANO, Stefania, WOLF, Ingrid H, DE ROSA, Gaetano, SOYER, H. Peter, CORONA, Rosamaria, SERA, Francesco, BRUNETTI, Bruno, CERRONI, Lorenzo, CHIMENTI, Sergio, EL SHABRAWI-CAELEN, Laila, FERRARI, Angela
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Aged; Aged, 80 and over; Biological and medical sciences; Child; Cytodiagnosis - methods; Dermatology; Diagnosis, Differential; Female; Humans; Male; Medical sciences; Melanoma - diagnosis; Melanoma - pathology; Microscopy; Middle Aged; Observer Variation; Professional Competence; Retrospective Studies; Sensitivity and Specificity; Skin Neoplasms - diagnosis; Skin Neoplasms - pathology; Tumors of the skin and soft tissue. Premalignant lesions
• ISSN: 0008-543X; 1097-0142
• DOI: 10.1002/cncr.10768

Dermoscopy (dermatoscopy, epiluminescence microscopy) is increasingly employed for the preoperative detection of cutaneous melanoma; dermoscopic features of pigmented skin lesions have been previously defined using histopathology as the key to the code. In a preliminary study on 10 cases evaluated by nine dermoscopists and nine histopathologists, the authors experienced that when at least two dermoscopists disagree in evaluating a melanocytic lesion, even histopathologic consultations may give equivocal results. One hundred seven melanocytic skin lesions, consecutively excised because of equivocal clinical and/or dermoscopic features, were retrospectively examined by eight dermoscopists and eight histopathologists; the diagnostic interobserver agreement was calculated by means of the Schouten k statistics. After histopathologic consultations, all 107 lesions underwent unblinded dermoscopic re-evaluation in order to find which dermoscopic features had given rise to histopathologic diagnostic difficulties. The interobserver ageement was good for both dermoscopy (k = 0.53) and histopathology (k = 0.74). Out of 48 cases evaluated by the dermoscopists in complete accordance, only 8 (16.7%) received at least one conflicting histopathologic diagnosis. Instead, among the remaining 59 cases with at least one disagreeing dermoscopic diagnosis, 21 (35.6%) received at least one disagreeing histopathologic diagnosis. The unblinded dermoscopic re-evaluation showed that five out of seven lesions with clear-cut regression structures were histopathologically controversial. At least for selected and reasonably difficult lesions, a diagnostic discrepancy among formally trained dermoscopists seems to be predictive for a diagnostic disagreement among histopathologists. Lesions showing clear-cut regression structures are prone to give some histopathologic disagreement.