Sensitivity and specificity of epiluminescence microscopy: evaluation on asample of 2731 excised cutaneous pigmented lesions

To evaluate the role of epiluminescence microscopy (ELM) in the differentia l diagnosis of cutaneous pigmented lesions, and to improve the early diagno sis of cutaneous malignant melanoma (CMM), 15,719 pigmented lesions from 87 82 consecutive patients were evaluated using ELM with a hand-held video mic roscope imaging system (MS 500B Micro-Scopeman, Moritex). Comparison betwee n risk levels as inferred from ELM screening and histology was performed on 2731 surgically excised lesions, ELM sensitivity, specificity, positive an d negative predictive values, as well as agreement with histological result s for the different subgroups of lesions, were determined. Overall agreemen t was 87.3% (ranging from 85.1% to 92.2% for melanocytic and non-melanocyti c lesions, respectively); sensitivity and specificity were high (values ran ging from 87.3% to 96.3% among different subsets of ELM-analysed lesions) a nd statistically significant (P < 0.0001), ELM screening identified 165 new cases of CMM with a high proportion of lesions (115; 70%) in an early phas e of tumour growth (Breslow thickness less than or equal to 1.5 mm), Thus, ELM is helpful to the clinician in deciding which pigmented lesions need su rgical excision, as well as in diagnosing early CMM lesions.