ORIGINAL ARTICLES   

Giornale Italiano di Dermatologia e Venereologia 2005 February;140(1):15-25

Copyright © 2005 EDIZIONI MINERVA MEDICA

language: English, Italian

The epiluminescence microscopy in the ambulatory clinical practice: diagnostic accuracy and usefulness of videodermatoscopic monitoring

Broganelli P. ¹, Chiaretta A. ¹, Sacerdote C. ², Pippione M. ¹

¹ Dermatology Clinic II, Department of Biomedical Science University of Turin, Turin, Italy 2 Unit of Cancer Epidemiology S. Giovanni Battista Hospital, Turin, Italy

Aim. To evaluate the sensitivity, specificity and accuracy of epiluminescence microscopy (ELM) in distinguishing melanocytic from non-melanocytic lesions and in diagnosing melanomas in melanocytic lesions. Also, to assess the usefulness of dermatoscopic follow-up exams in detecting possible false-negative diagnoses.
Methods. Reported data refers to the ambulatory clinical practice conducted in the 5-year period 1998-2002. We observed in ELM 27 885 pigmented skin lesions (melanocytic and non-melanocytic) in 10 974 patients. Those lesions were considered suspicious according to the patient’s history and to clinical parameters. Of those lesions, 735 (or 2.64%) were surgically removed and histologically examined for the presence of atypical dermoscopic features. For the other lesions follow up exams were scheduled after approximately 3-6-12 months.
Results. ELM showed an accuracy of 98.76% in distinguishing melanocytic from non-melanocytic lesions, and also showed a sensitivity of 92.59%, a specificity of 98.11% and an accuracy of 84.75% in distinguishing melanomas from other melanocytic lesions (non-melanomas). Any diagnostic errors were revaluated following histological diagnosis (which is considered to be the gold standard of such exams). It was only possible to conduct videodermatoscopic monitoring exams on 17 253 lesions of the 26 089 planned due to lack of compliance with respect to the remaining 8 836 (or 33.87%). Eighty-five lesions (or 0.49% of the lesions re-evaluated at follow-up exams) presented substantial modifications (dimensional increase associated with the appearance of ELM suspicious parameters) at the dermoscopic follow-up exam conducted after 3-6 months from the first observation. Such lesions were consequently surgically removed, thus allowing discovery of 6 melanomas (max thickness 0.4 mm).
Conclusion. According to our experience, it is possible to reduce the risk of false-negative diagnoses by associating the clinical and dermoscopic evaluations. The re-evaluation of non removed lesions after a short period of time through sequential and standardized imaging allows identification of possible modifications in shape of those lesions which, in 6 cases (or 0.035%), conducted to the discovery of false negative diagnoses. This diagnostic approach permits to reduce the number of “prudential excisions” especially in patients with multiple Clark’s nevi.