A METHOD FOR THE DIAGNOSIS OF PRIMARY CUTANEOUS MELANOMA USING SURFACE MICROSCOPY
Section snippets
METHOD DEVELOPMENT
A training set of 62 invasive melanomas and 159 clinically atypical pigmented nonmelanomas were scored for 72 surface microscopic features.8 The nonmelanoma set included nonmelanocytic lesions, such as seborrheic keratoses, hemangiomas, and dermatofibromas. To create the model, individual features were selected with low sensitivity (0%) for melanoma, defining the two “negative features”, or high specificity (>85%) for melanoma, defining the 9 “positive features.”7 This diagnostic method (Table
THE METHOD
For a melanoma to be diagnosed, it must have neither of the two morphologic negative features and one or more of the nine positive features. The following describes each feature.5
FALSE-NEGATIVE MELANOMAS
Although 92% of invasive melanomas can be diagnosed using this method, 8% fail to be diagnosed using the above criteria.7 These can be divided into two categories: some early, thin, pigmented melanomas, and hypomelanotic melanomas. The latter defines an important group because it may not be thin on presentation. These melanomas often are highly vascular, with pin-point, hairpin, or less commonly, arborising telangiectasia. This vascularity often can distinguish these lesions from benign nevi (
IN-SITU MELANOMA
Lentigo maligna or other variants of in-situ melanoma can be diagnosed using the above method because they frequently have the positive features of broadened network and, to a lesser extent, multiple blue-gray dots. Less frequently, multiple brown dots, peripheral black dots, pseudopods, and radial streaming may be present; however, as yet, the method has not been formally tested on a large series of in situ melanoma.
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Address reprint requests to Scott W. Menzies, MBBS, PhD Sydney Melanoma Unit, Royal Prince Alfred Hospital Missenden Rd Camperdown NSW 2050, Australia [email protected]
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Department of Surgery, University of Sydney; and the Sydney Melanoma Unit, Melanoma and Skin Cover Research Institute, Royal Prince Alfred Hospital, New South Wales, Australia