H. Kittler et al., Morphologic changes of pigmented skin lesions: A useful extension of the ABCD rule for dermatoscopy, J AM ACAD D, 40(4), 1999, pp. 558-562
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.