A Lallas1, P Tschandl2, A Kyrgidis1, W Stolz3, H Rabinovitz4, A Cameron5, J Y Gourhant6, J Giacomel7, H Kittler2, J Muir8, G Argenziano9, R Hofmann-Wellenhof10, I Zalaudek10. 1. Skin Cancer Unit, Arcispedale Santa Maria Nuova IRCCS, Viale Risorgimento 80, 42100, Reggio Emilia, Italy. 2. Department of Dermatology, Medical University of Vienna, Vienna, Austria. 3. Department of Dermatology, Allergology and Environmental Medicine II, Hospital Thalkirchner Straße, Städtisches Klinikum Munich, Munich, Germany. 4. Skin and Cancer Associates, Plantation, FL, U.S.A. 5. School of Medicine, University of Queensland, Brisbane, Qld, Australia. 6. Dermatology Practice, Nemours, France. 7. Skin Spectrum Medical Services, Como, WA, Australia. 8. School of Medicine, The University of Queensland, Brisbane, Qld, Australia. 9. Dermatology Unit, Second University of Naples, Naples, Italy. 10. Department of Dermatology and Venerology, Non-Melanoma Skin Cancer Unit, Medical University of Graz, Graz, Austria.
Abstract
BACKGROUND: Dermoscopy is limited in differentiating accurately between pigmented lentigo maligna (LM) and pigmented actinic keratosis (PAK). This might be related to the fact that most studies have focused on pigmented criteria only, without considering additional recognizable features. OBJECTIVES: To investigate the diagnostic accuracy of established dermoscopic criteria for pigmented LM and PAK, but including in the evaluation features previously associated with nonpigmented facial actinic keratosis. METHODS: Retrospectively enrolled cases of histopathologically diagnosed LM, PAK and solar lentigo/early seborrhoeic keratosis (SL/SK) were dermoscopically evaluated for the presence of predefined criteria. Univariate and multivariate regression analyses were performed and receiver operating characteristic curves were used. RESULTS: The study sample consisted of 70 LMs, 56 PAKs and 18 SL/SKs. In a multivariate analysis, the most potent predictors of LM were grey rhomboids (sixfold increased probability of LM), nonevident follicles (fourfold) and intense pigmentation (twofold). In contrast, white circles, scales and red colour were significantly correlated with PAK, posing a 14-fold, eightfold and fourfold probability for PAK, respectively. The absence of evident follicles also represented a frequent LM criterion, characterizing 71% of LMs. CONCLUSIONS: White and evident follicles, scales and red colour represent significant diagnostic clues for PAK. Conversely, intense pigmentation and grey rhomboidal lines appear highly suggestive of LM.
BACKGROUND: Dermoscopy is limited in differentiating accurately between pigmented lentigo maligna (LM) and pigmented actinic keratosis (PAK). This might be related to the fact that most studies have focused on pigmented criteria only, without considering additional recognizable features. OBJECTIVES: To investigate the diagnostic accuracy of established dermoscopic criteria for pigmented LM and PAK, but including in the evaluation features previously associated with nonpigmented facial actinic keratosis. METHODS: Retrospectively enrolled cases of histopathologically diagnosed LM, PAK and solar lentigo/early seborrhoeic keratosis (SL/SK) were dermoscopically evaluated for the presence of predefined criteria. Univariate and multivariate regression analyses were performed and receiver operating characteristic curves were used. RESULTS: The study sample consisted of 70 LMs, 56 PAKs and 18 SL/SKs. In a multivariate analysis, the most potent predictors of LM were grey rhomboids (sixfold increased probability of LM), nonevident follicles (fourfold) and intense pigmentation (twofold). In contrast, white circles, scales and red colour were significantly correlated with PAK, posing a 14-fold, eightfold and fourfold probability for PAK, respectively. The absence of evident follicles also represented a frequent LM criterion, characterizing 71% of LMs. CONCLUSIONS: White and evident follicles, scales and red colour represent significant diagnostic clues for PAK. Conversely, intense pigmentation and grey rhomboidal lines appear highly suggestive of LM.