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Dermoscopic and histopathologic diagnosis of equivocal melanocytic skin lesions
Author(s) -
Ferrara Gerardo,
Argenziano Giuseppe,
Soyer H. Peter,
Corona Rosamaria,
Sera Francesco,
Brunetti Bruno,
Cerroni Lorenzo,
Chimenti Sergio,
El ShabrawiCaelen Laila,
Ferrari Angela,
HofmannWellenhof Rainer,
Kaddu Steven,
Piccolo Domenico,
Scalvenzi Massimiliano,
Staibano Stefania,
Wolf Ingrid H.,
De Rosa Gaetano
Publication year - 2002
Publication title -
cancer
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.052
H-Index - 304
eISSN - 1097-0142
pISSN - 0008-543X
DOI - 10.1002/cncr.10768
Subject(s) - medicine , dermatoscopy , histopathology , dermatology , melanoma , skin lesion , lesion , skin cancer , diagnostic accuracy , melanoma diagnosis , pathology , radiology , cancer , cancer research
BACKGROUND Dermoscopy (dermatoscopy, epiluminescence microscopy) is increasingly employed for the preoperative detection of cutaneous melanoma; dermoscopic features of pigmented skin lesions have been previously defined using histopathology as the key to the code. In a preliminary study on 10 cases evaluated by nine dermoscopists and nine histopathologists, the authors experienced that when at least two dermoscopists disagree in evaluating a melanocytic lesion, even histopathologic consultations may give equivocal results. METHODS One hundred seven melanocytic skin lesions, consecutively excised because of equivocal clinical and/or dermoscopic features, were retrospectively examined by eight dermoscopists and eight histopathologists; the diagnostic interobserver agreement was calculated by means of the Schouten k statistics. After histopathologic consultations, all 107 lesions underwent unblinded dermoscopic re‐evaluation in order to find which dermoscopic features had given rise to histopathologic diagnostic difficulties. RESULTS The interobserver ageement was good for both dermoscopy ( k = 0.53) and histopathology ( k = 0.74). Out of 48 cases evaluated by the dermoscopists in complete accordance, only 8 (16.7%) received at least one conflicting histopathologic diagnosis. Instead, among the remaining 59 cases with at least one disagreeing dermoscopic diagnosis, 21 (35.6%) received at least one disagreeing histopathologic diagnosis. The unblinded dermoscopic re‐evaluation showed that five out of seven lesions with clear‐cut regression structures were histopathologically controversial. CONCLUSIONS At least for selected and reasonably difficult lesions, a diagnostic discrepancy among formally trained dermoscopists seems to be predictive for a diagnostic disagreement among histopathologists. Lesions showing clear‐cut regression structures are prone to give some histopathologic disagreement. Cancer 2002;95:1094–1100. © 2002 American Cancer Society. DOI 10.1002/cncr.10768