Dermoscopic Structures and Patterns Important for Accurately Detecting Melanoma

Findings from a systematic review and meta-analysis support the diagnostic importance of dermoscopic structures associated with melanoma detection and highlight the importance of the overall pattern (JAMA Dermatol. 2021; e212845. doi:10.1001/jamadermatol.2021.2845).

While dermoscopy is associated with increasing the diagnostic accuracy for melanoma, the accuracy of individual structures and patterns used in melanoma detection is unknown.

Natalie Williams, MD, Dr Phillip Frost Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, Florida, and colleagues aimed to “assess the diagnostic accuracy of individual dermoscopic structures and patterns used in melanoma detection.”

Ovid Medline, Embase, Cochrane CENTRAL, Scopus, and Web of Science were used to identify studies evaluating the dermoscopic structures and patterns among melanomas in comparison with nonmelanoma lesions. Only studies published in English or Spanish, with 3 or more patients were included in this assessment.

Authors followed The Preferred Reporting Items for Systematic Reviews and Meta-analyses reporting guideline and Meta-analysis of Observational Studies in Epidemiology reporting guideline. A random-effects model pooled the data.

Diagnostic accuracy and risk of melanoma for dermoscopic structures/patterns, including atypical dots/globules, atypical network, blue-white veil, negative network, off-centered blotch, peripheral-tan structureless areas, atypical vessels, pseudopods, streaks, regression shiny white structures, angulated lines, irregular pigmentation, and a multicomponent pattern were prespecified outcome measures.

In total, 22,796 skin lesions and 5736 melanomas were observed throughout the 40 studies included in this evaluation. The highest ORs were observed in shiny white structures (OR, 6.7), pseudopods (OR, 6.7), irregular pigmentation (OR, 6.4; 95% CI, 2.0-20.5), blue-white veil (OR, 6.3), and peppering (OR, 6.3). The highest specificity was observed in were pseudopods (97.3%), shiny white structures (93.6), peppering (93.4%), and streaks (92.1%). The highest sensitivity was observed in irregular pigmentation (62.3%; 95% CI, 31.2%-85.8%), blue-white veil (60.6%), atypical network (56.8%), and a multicomponent pattern (53.7%).

“The findings of this systematic review and meta-analysis support the diagnostic importance of dermoscopic structures associated with melanoma detection (eg, shiny white structures, blue-white veil), further corroborate the importance of the overall pattern, and may suggest a hierarchy in the significance of these structures and patterns,” Dr Williams and colleagues concluded.—Marta Rybczynski