SENSITIVITY AND SPECIFICITY OF CLINICAL-CRITERIA IN THE DETECTION OF HISTOLOGIC ATYPIA IN NEVI

A retrospective, double-blinded clinicopathological study was performe d in a series of acquired melanocytic nevi (n = 128) to assess the lev el of concordance between clinical and histopathological features and to analyze the sensitivity and the specificity of clinical parameters in the detection of histological atypia. The overall concordance betwe en clinical and histological aspects was poor (Cohen's K statistics = 0.21; 95% Cl = 0.13-0.30): in the group of clinically common nevi, the 50% of them were histologically common melanocytic nevi (CMN), 41% we re nevi with architectural disorder (NAD) and 9% were nevi with archit ectural disorder plus cytologic atypia (NADCA); in the group of nevi w ith mild clinical atypia, 22% were CMN, 64% were NAD and 14% were NADC A; in the group of nevi with severe clinical atypia, 13% were CMN, 56% were NAD and 31% were NADCA. The most sensitive clinical parameters t o predict histologic atypia were macular surface (naevus not palpable) , dark-brown color and ill-defined border (sensitivity ranging from 54 to 90% for NAD; 60-100% for NADCA); their specificity ranged from 44% to 70%. The most specific parameters resulted erythema (100%), pigmen tation with a black or pink hue (91%-97%) and accentuated skin marking s (88%). The sensitivity of these parameters ranged from 1% to 32%. No ne of combinations of different parameters showed a significant improv ement in terms of sensitivity/specificity. From our data, the poor cli nico-pathological concordance observed in nevi excised in subjects wit hout personal and familial history for cutaneous melanoma makes the cl inical detection of histologic atypia unreliable.