Morphologic changes of pigmented skin lesions: A useful extension of the ABCD rule for dermatoscopy

Background: Epiluminescence microscopy (ELM) significantly increases the ea rly diagnosis of pigmented skin lesions (PSL) using established criteria an d pattern analysis. The ABCD rule for dermatoscopy (ie, ELM) provides a sim plified approach to the interpretation of ELM images on the basis of asymme try (A), border (B), color (C), and dermatoscopic structure (D). Objective: We set out to determine whether the diagnostic accuracy of the A BCD scoring algorithm can be significantly improved by incorporating inform ation about morphologic changes of the lesion observed and provided by the patient. Methods: We prospectively collected 356 small pigmented skin lesions (< 1 c m) including 73 (20.5%) melanomas. Before excision all patients were asked whether the lesion had changed in size, color, or shape within the last yea r or whether they experienced any sign of ulceration or spontaneous bleedin g. ELM images of the lesions were evaluated according to the ABCD rule for dermatoscopy to yield a semiquantitative score. Accuracy of diagnosis was e valuated in terms of sensitivity, specificity, and area under receiver oper ating characteristic curves (AUC). Results: The frequency of reported changes was significantly higher for mel anomas than benign PSL (65.8% vs 29.7%, P < .001). In a multivariate model morphologic change was a significant independent predictor of malignancy (o dds ratio = 3.17, 95% confidence interval [CI]: 1.96 to 5.14, P < .001). Th e mean final score achieved when using the enhanced ABCD-E criteria includi ng morphologic change (E) was significantly higher for melanomas (5.7, 95% CI: 5.3 to 6.0) than benign PSL (2.9, 95% CI: 2.8 to 3.1, P < .001), Diagno stic accuracy was significantly higher when the lesions were evaluated by t he enhanced ABCD-E criteria as compared with the standard ABCD score (AUC(A BCD) = 0.87 vs AUC(ABCD-E) = 0.90; P = .006). Conclusion: Information about morphologic changes of PSL as reported by the patient is a useful extension of the ABCD rule for dermatoscopy.