Epiluminescence microscopy as a useful approach in the early diagnosis of cutaneous malignant melanoma

The aim of this study was to evaluate the role of epiluminescence microscop y (ELM) in the differential diagnosis of cutaneous pigmented lesions in ord er to improve the detection of cutaneous malignant melanoma (CMM) at earlie r stages of the disease. In total, 3865 pigmented lesions from 2121 selecte d patients were evaluated using ELM with a hand held video microscope imagi ng system (MS 500B Micro-Scopeman, Moritex). Comparison with histology was performed on the 476 surgically excised lesions, ELM sensitivity, specifici ty, positive and negative predictive values as well as agreement for the di fferent risk levels of the lesions were determined, Of the 476 cutaneous pi gmented lesions removed and histologically examined, 101 (21.2%) were non-m elanocytic lesions and 375 (78.8%) were melanocytic lesions. Overall agreem ent was 83.4% (93.1% and 80.8% for non-melanocytic and melanocytic lesions, respectively). Sensitivity and specificity of ELM in the analysis of melan ocytic lesions with a pigment network were both very high (92.3% and 91.2%, respectively). Sixty new cases of CMM were identified, A high proportion o f melanoma at stage AJCC IA (23 out of 32; 71.8%) was diagnosed exclusively by ELM (four of these were in site CCM lesions). ELM is therefore a powerf ul tool to discriminate between melanocytic and non-melanocytic lesions in order to avoid inopportune surgical treatments for low risk lesions. Unfort unately, ELM did not show 100% sensitivity in diagnosing CMM and therefore ELM features should be integrated with data from both the history and clini cal evaluation. However, ELM is much more accurate than clinical examinatio n in detecting thin CMM. (C) 1998 Lippincott Williams & Wilkins.