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Frequency and morphologic characteristics of invasive melanomas lacking specific surface microscopic features
S W Menzies1, C Ingvar, K A Crotty
1Department of Surgery (Sydney Melanoma Unit), University of Sydney, Australia.
Archives of Dermatology
|October 1, 1996
Summary
Surface microscopy aids invasive melanoma diagnosis but isn't foolproof. Clinical history is crucial for "featureless" lesions, improving diagnostic accuracy for skin cancer.
Area of Science:
- Dermatology
- Oncology
- Medical Diagnostics
Background:
- Invasive melanoma diagnosis relies on accurate detection.
- Cutaneous surface microscopy (dermoscopy) is a key diagnostic tool.
- Some invasive melanomas present with subtle or absent diagnostic features.
Purpose of the Study:
- To develop a simple diagnostic method for invasive melanoma using in vivo cutaneous surface microscopy.
- To analyze the incidence and characteristics of invasive melanomas lacking typical diagnostic features.
Main Methods:
- A diagnostic model was created using 72 surface microscopic features from a training set of invasive melanomas and non-melanomas.
- The model's sensitivity and specificity were evaluated on a separate test set.
- Lesions were photographed with immersion oil, excised, and histologically diagnosed.
Main Results:
- The diagnostic model achieved 92% sensitivity and 71% specificity for invasive melanoma.
- Nine melanomas were missed; six were thin and pigmented, three were thicker, hypomelanotic lesions.
- Missed melanomas often had subtle pigment networks or lacked them, with some showing telangiectases.
Conclusions:
- Cutaneous surface microscopy alone cannot guarantee 100% sensitivity for invasive melanoma diagnosis.
- Clinical history, particularly changes in lesion appearance, is vital for diagnosing featureless melanomas.
- Surface microscopy should not be the sole criterion for melanoma excision.