Melanoma Detection in Pigmented Lesions ≤ 6 mm Selected for Excision After Dermoscopy in Routine Practice: A...

Area of Science:

• Dermatology
• Oncology
• Dermatopathology

Background:

• Dermoscopy aids in identifying suspicious pigmented lesions.
• The diagnostic efficiency of excising small lesions (≤ 6 mm) for melanoma is not well-defined.

Purpose of the Study:

• Quantify melanoma detection yield and number needed to excise (NNE) for lesions ≤ 6 mm.
• Compare diagnostic yield between small (≤ 6 mm) and larger (> 6 mm) suspicious pigmented lesions.
• Describe melanoma characteristics based on lesion diameter.

Main Methods:

• Retrospective observational study at a tertiary dermatologic oncology referral center.
• Included pigmented lesions excised due to suspected melanoma (Jan 2022-Dec 2023).
• Analyzed melanoma yield and NNE, stratified by lesion diameter, using multivariable logistic regression.

Main Results:

• Overall melanoma yield was 27.2% (609/2240).
• Lesions ≤ 6 mm had a 13.1% yield and NNE of 7.6, while lesions > 6 mm had a 47.7% yield and NNE of 2.1.
• Lesions > 6 mm were significantly more likely to be melanoma (adjusted OR 4.77).

Conclusions:

• Excision of small (≤ 6 mm) suspicious lesions has a lower melanoma yield and higher NNE compared to larger lesions.
• Findings support risk-stratified management and re-evaluation of excision thresholds for very small pigmented lesions.
• Melanomas in smaller lesions exhibited a more favorable histopathologic profile.