The BRAAFF checklist: a new dermoscopic algorithm for diagnosing acral melanoma

Area of Science:

• Dermatology
• Oncology
• Medical Imaging

Background:

• The parallel ridge pattern (PRP) is a key dermoscopic feature of acral melanoma (AM).
• A significant proportion of acral melanomas lack the characteristic PRP, complicating their diagnosis.
• Improved diagnostic tools are needed for acral melanoma detection.

Purpose of the Study:

• To evaluate the diagnostic accuracy of various dermoscopic criteria for acral melanoma.
• To identify a reliable set of dermoscopic features for diagnosing AM.
• To enhance the early detection of acral melanoma.

Main Methods:

• Dermoscopic images of 603 lesions (131 AMs, 472 nevi) were analyzed by three independent investigators.
• Predefined dermoscopic criteria were assessed.
• Logistic regression and receiver operating characteristic (ROC) curves were used to develop and validate a diagnostic scoring system.

Main Results:

• A six-variable scoring system, termed BRAAFF, demonstrated optimal diagnostic performance.
• The BRAAFF checklist includes positive predictors (irregular blotches, ridge pattern, asymmetry of structures, asymmetry of colors) and negative predictors (furrow pattern, fibrillar pattern).
• The BRAAFF system achieved optimal area under the curve and sensitivity for AM diagnosis.

Conclusions:

• The BRAAFF checklist significantly improves the diagnostic accuracy of dermoscopy for acral melanoma.
• This scoring system offers a valuable tool for the detection of AM, especially those lacking typical features.
• Enhanced dermoscopic evaluation using BRAAFF can aid in the timely diagnosis of acral melanoma.