Epiluminescence microscopy for the diagnosis of doubtful melanocytic skin lesions - Comparison of the ABCD rule of dermatoscopy and a new 7-Point checklist based on pattern analysis

Objective: To compare the reliability of a new 7-point checklist based on s implified epiluminescence microscopy (ELM) pattern analysis with the ABCD r ule of dermatoscopy and standard pattern analysis for the diagnosis of clin ically doubtful melanocytic skin lesions. Design: In a blind study, ELM images of 342 histologically proven melanocyt ic skin lesions were evaluated for the presence of 7 standard criteria that we called the "ELM 7-point checklist." For each lesion, "overall" and "ABC D scored" diagnoses were recorded. From a training set of 57 melanomas and 139 atypical non-melanomas, odds ratios were calculated to create a simple diagnostic model based on identification of major and minor criteria for th e "7-point scored" diagnosis. A test set of 60 melanomas and 86 atypical no n-melanomas was used for model validation and was then presented to 2 less experienced ELM observers, who recorded the ABCD and 7-point scored diagnos es. Settings: University medical centers. Patients: A sample of patients with excised melanocytic lesions. Main Overcome Measures: Sensitivity, specificity, and accuracy of the model s for diagnosing melanoma. Results: From the total combined sets, the 7-point checklist gave a sensiti vity of 95% and a specificity of 75% compared with 85% sensitivity and 66% specificity using the ABCD rule and 91% sensitivity and 90% specificity usi ng standard pattern analysis (overall ELM diagnosis). Compared with the ABC D rule, the 7-point method allowed less experienced observers to obtain hig her diagnostic accuracy values. Conclusions: The ELM 7-point checklist provides a simplification of standar d pattern analysis because of the low number of features to identify and th e scoring diagnostic system. As with the ABCD rule, it can be easily learne d and easily applied and has proven to be reliable in diagnosing melanoma.