Original article
Seven-point checklist for dermatoscopy: Performance during 10 years of prospective surveillance of patients at increased melanoma risk

https://doi.org/10.1016/j.jaad.2009.08.049Get rights and content

Background

The retrospectively developed 7-point checklist is one of the most applicable dermatoscopic algorithms for clinical use. However, until today no prospective data on the diagnostic performance of this algorithm were reported.

Objective

Our aim was to assess the sensitivity, specificity, and diagnostic accuracy of the 7-point checklist in the setting of a prospective long-term study.

Methods

Patients at increased melanoma risk (n = 688) were screened at regular intervals by naked-eye examination, the dermatoscopic 7-point checklist, and digital dermatoscopy follow-up (10-year study interval).

Results

We detected 127 melanomas including 50 melanomas in situ. The mean Breslow thickness of invasive melanomas was 0.57 mm. A total of 79 melanomas displayed the 7-point checklist melanoma threshold of 3 or more points (62% sensitivity, compared with 78%-95% in retrospective settings). In all, 48 melanomas scored fewer than 3 points and were excised because of complementary information (eg, lesional history, dynamic changes detected by digital dermatoscopy). The specificity of the 7-point checklist was 97% (compared with 65%-87% in retrospective settings). Regression patterns, atypical vascular patterns, and radial streaming were associated with the highest relative risk for melanoma (odds ratio 3.26, 95% confidence interval 2.05-5.16; odds ratio 3.04, 95% confidence interval 1.70-5.46; odds ratio 2.91, 95% confidence interval 1.64-5.15; P < .0003, respectively). Melanomas thicker than 0.5 mm exhibited significantly more regression patterns and atypical vascular patterns (P < .02). The malignant versus benign ratio for all excised lesions was 1:8.6 (127 melanomas, 1092 nonmelanomas).

Limitations

Calculation of the specificity was a limitation. True negative lesions were defined by a score less than 3 points and either the histopathological diagnosis of nonmelanoma or the absence of dynamic changes during digital dermatoscopy follow-up (nonexcised, nonsuspicious, no change).

Conclusions

The 7-point checklist for dermatoscopy was less sensitive but highly specific in this prospective clinical setting. Complementary information clearly increased the sensitivity. Regression patterns or radial streaming in nevi of patients at high risk should raise a higher melanoma suspicion than might be concluded from retrospective studies.

Section snippets

Patients' examination

All clinical investigation was conducted according to the Declaration of Helsinki Principles. Institutional approval and patient consent were obtained. Patients' characteristics, including age, sex, hair color, eye color, skin type (I-IV, Fitzpatrick classification), presence of ephelides, the estimated whole-body number of nevi, the personal/family history of melanoma, and the histologic results of former excisional biopsy specimens, were prospectively entered into a database. Patients were

General data

Data of 688 patients (mean age 42 years, 295 female, 393 male) were collected during 10 years. The mean follow-up time per patient was 44.28 (range 2-123) months. Patients were prospectively stratified into 3 risk groups. A total of 67% were assigned to group I (patients with >50 common and/or ≤3 atypical nevi), whereas 31.8% and 1.2% of patients were assigned to group II (AMS) and group III (familial atypical mole and multiple melanoma syndrome), respectively. A large proportion of patients

Discussion

The differentiation between atypical benign nevi and early melanoma is a considerable challenge for the clinician. Several retrospective studies with analysis of dermatoscopic images after lesions had already been excised have shown that algorithms for dermatoscopy improve the ability to distinguish between benign and malignant melanocytic lesions. However, no study today has tried to measure the real-life sensitivity for melanoma detection because that would require either removing all skin

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    • Cited by (0)

    Supported in part by the Cancer Society of Lower Saxony (Niedersächsische Krebsgesellschaft e.V., Hannover, Germany). The FotoFinder dermatoscope used in this study is a donation of Teachscreen Software GmbH (Bad Birnbach, Germany) to the University Hospital Göttingen.

    Conflicts of interest: None declared.

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    Copyright © 2010 American Academy of Dermatology, Inc. Published by Mosby, Inc. All rights reserved.