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Giornale Italiano di Dermatologia e Venereologia 2005 August;140(4):349-58


language: English, Italian

The problem of clinically atypical nevi submitted to verification biopsy: can dermoscopy help excluding histologically common lesions?

Chiarugi A., Nardini P., De Giorgi V., Carli P.

Department of Dermatology University of Florence, Florence, Italy


Aim. Early diagnosis of cutaneous melanoma is associated with costs in term of false positive diagnosis, i.e. benign pigmented lesions defined suspicious or equivocal by clinical examination and submitted to verification biopsy. The aim of the study is to investigate the possible role of dermoscopy in selecting histologically common nevi from those with histologic atypia.
Methods. Two hundred and sixthy-four clinically atypical melanocytic nevi were classified by experienced pathologists as nevi with histologic atypia and without histologic atypia. Two observers analysed dermoscopic features with classic pattern analysis and simplified algorithms. The study population was divided in a training set and in a test set (observers aware of histologic classification and blinded as to histologic classification respectively).
Results. In the training set, nevi with histologic atypia significantly differed from common nevi since they showed with higher frequency the following dermoscopic criteria: atypical pigment network, regression features, ABCD score ≥4 and seven point check list ≥2. In the test set, however, only atypical pigment network and seven point score ≥2 were still more frequent in atypical nevi than in common nevi. The negative predictive value was less than 70% for any of selected dermoscopic features. This means that when an observer predict that a nevus lacking the above-mentioned criteria of atypia is histologicaly common, it will be true in less than 70% of cases.
Conclusion. Dermoscopy can play a role in detecting banal melanocytic lesions, ie. nevi without histologic atypia, within the pool of clinically equivocal lesions submitted to verification biopsy. Further study with evidence-based design (prospective, randomised study) are needed to investigate the impact of dermoscopy in a better selection of lesions to remove in real practice.

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