Interobserver Agreement on Dermoscopic Features and their Associations with In Situ and Invasive Cutaneous Melanomas
DOI:
https://doi.org/10.2340/actadv.v101.281Keywords:
melanoma, observer variation, predictive value of tests, reproducibility of results, retrospective studyAbstract
Several melanoma-specific dermoscopic features have been described, some of which have been reported as indicative of in situ or invasive melanomas. To assess the usefulness of these features to differentiate between these 2 categories, a retrospective, single-centre investigation was conducted. Dermoscopic images of melanomas were reviewed by 7 independent dermatologists. Fleiss’ kappa (κ) was used to analyse interobserver agreement of predefined features. Logistic regression and odds ratios were used to assess whether specific features correlated with melanoma in situ or invasive melanoma. Overall, 182 melanomas (101 melanoma in situ and 81 invasive melanomas) were included. The interobserver agreement for melanoma-specific features ranged from slight to substantial. Atypical blue-white structures (κ=0.62, 95% confidence interval 0.59–0.65) and shiny white lines (κ=0.61, 95% confidence interval 0.58–0.64) had a substantial interobserver agreement. These 2 features were also indicative of invasive melanomas >1.0 mm in Breslow thickness. Furthermore, regression/peppering correlated with thin invasive melanomas. The overall agreement for classification of the lesions as invasive or melanoma in situ was moderate (κ=0.52, 95% confidence interval 0.49–0.56).
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Kittler H, Marghoob AA, Argenziano G, Carrera C, Curiel-Lewandrowski C, Hofmann-Wellenhof R, et al. Standardization of terminology in dermoscopy/dermatoscopy: results of the third consensus conference of the International Society of Dermoscopy. J Am Acad Dermatol 2016; 74: 1093-1106.
https://doi.org/10.1016/j.jaad.2015.12.038 DOI: https://doi.org/10.1016/j.jaad.2015.12.038
Silva VP, Ikino JK, Sens MM, Nunes DH, Di Giunta G. Dermoscopic features of thin melanomas: a comparative study of melanoma in situ and invasive melanomas smaller than or equal to 1mm. Anais Brasileiros de Dermatologia 2013; 88: 712-717.
https://doi.org/10.1590/abd1806-4841.20132017 DOI: https://doi.org/10.1590/abd1806-4841.20132017
Lallas A, Longo C, Manfredini M, Benati E, Babino G, Chinazzo C, et al. Accuracy of dermoscopic criteria for the diagnosis of melanoma in situ. JAMA Dermatol 2018; 154: 414-419.
https://doi.org/10.1001/jamadermatol.2017.6447 DOI: https://doi.org/10.1001/jamadermatol.2017.6447
Argenziano G, Fabbrocini G, Carli P, De Giorgi V, Delfino M. Clinical and dermatoscopic criteria for the preoperative evaluation of cutaneous melanoma thickness. J Am Acad Dermatol 1999; 40: 61-68.
https://doi.org/10.1016/S0190-9622(99)70528-1 DOI: https://doi.org/10.1016/S0190-9622(99)70528-1
Isaksson K, Mikiver R, Eriksson H, Lapins J, Nielsen K, Ingvar C, et al. Survival in 31670 patients with thin melanomas: a Swedish population-based study. Br J Dermatol 2021; 184: 60-67.
https://doi.org/10.1111/bjd.19015 DOI: https://doi.org/10.1111/bjd.19015
Maskalane J, Salijuma E, Lallas K, Papageorgiou C, Gkentsidi T, Manoli MS, et al. Distribution of the dermoscopic features of melanoma of trunk and extremities according to the anatomic sublocation. J Am Acad Dermatol 2021; 84: 1717-1719.
https://doi.org/10.1016/j.jaad.2020.08.058 DOI: https://doi.org/10.1016/j.jaad.2020.08.058
Marghoob AA, Braun R. Proposal for a revised 2-step algorithm for the classification of lesions of the skin using dermoscopy. Arch Dermatol 2010; 146: 426-428.
https://doi.org/10.1001/archdermatol.2010.41 DOI: https://doi.org/10.1001/archdermatol.2010.41
Fleiss JL. Measuring nominal scale agreement among many raters. Psychol Bull 1971; 76: 378.
https://doi.org/10.1037/h0031619 DOI: https://doi.org/10.1037/h0031619
Landis JR, Koch GG. The measurement of observer agreement for categorical data. Biometrics 1977; 33: 159-174.
https://doi.org/10.2307/2529310 DOI: https://doi.org/10.2307/2529310
Carrera C, Marchetti MA, Dusza SW, Argenziano G, Braun RP, Halpern AC, et al. Validity and reliability of dermoscopic criteria used to differentiate nevi from melanoma: a web-based international dermoscopy society study. JAMA Dermatol 2016; 152: 798-806.
https://doi.org/10.1001/jamadermatol.2016.0624 DOI: https://doi.org/10.1001/jamadermatol.2016.0624
Shitara D, Ishioka P, Alonso-Pinedo Y, Palacios-Bejarano L, Carrera C, Malvehy J, et al. Shiny white streaks: a sign of malignancy at dermoscopy of pigmented skin lesions. Acta Derm Venereol 2014; 94: 132-137.
https://doi.org/10.2340/00015555-1683 DOI: https://doi.org/10.2340/00015555-1683
Verzi AE, Quan VL, Walton KE, Martini MC, Marghoob AA, Garfield EM, et al. The diagnostic value and histologic correlate of distinct patterns of shiny white streaks for the diagnosis of melanoma: a retrospective, case-control study. J Am Acad Dermatol 2018; 78: 913-919.
https://doi.org/10.1016/j.jaad.2017.11.021 DOI: https://doi.org/10.1016/j.jaad.2017.11.021
Dyson SW, Bass J, Pomeranz J, Jaworsky C, Sigel J, Somach S. Impact of thorough block sampling in the histologic evaluation of melanomas. Arch Dermatol 2005; 141: 734-736.
https://doi.org/10.1001/archderm.141.6.734 DOI: https://doi.org/10.1001/archderm.141.6.734
Bishop J, Tallon B. Number of levels required to assess Breslow thickness in cutaneous invasive melanoma: an observational study. J Cutan Pathol 2019; 46: 819-822.
https://doi.org/10.1111/cup.13541 DOI: https://doi.org/10.1111/cup.13541
Seidenari S, Ferrari C, Borsari S, Benati E, Ponti G, Bassoli S, et al. Reticular grey-blue areas of regression as a dermoscopic marker of melanoma in situ. Br J Dermatol 2010; 163: 302-309.
https://doi.org/10.1111/j.1365-2133.2010.09821.x DOI: https://doi.org/10.1111/j.1365-2133.2010.09821.x
Ko CJ, Braverman I, Sidlow R, Lowenstein EJ. Visual perception, cognition, and error in dermatologic diagnosis: key cognitive principles. J Am Acad Dermatol 2019; 81: 1227-1234.
https://doi.org/10.1016/j.jaad.2018.10.082 DOI: https://doi.org/10.1016/j.jaad.2018.10.082
Croskerry P. The importance of cognitive errors in diagnosis and strategies to minimize them. Acad Med 2003; 78: 775-780.
https://doi.org/10.1097/00001888-200308000-00003 DOI: https://doi.org/10.1097/00001888-200308000-00003
El Sharouni MA, Aivazian K, Witkamp AJ, Sigurdsson V, van Gils CH, Scolyer RA, et al. Association of histologic regression with a favorable outcome in patients with stage 1 and stage 2 cutaneous melanoma. JAMA Dermatol 2021; 157: 166-173.
https://doi.org/10.1001/jamadermatol.2020.5032 DOI: https://doi.org/10.1001/jamadermatol.2020.5032
Swedish guidelines for malignant melanoma (In Swedish). Last updated: March 19, 2021 Available at:
Garbe C, Amaral T, Peris K, Hauschild A, Arenberger P, Bastholt L, et al. European consensus-based interdisciplinary guideline for melanoma. Part 2: Treatment - update 2019. Eur J Cancer 2020; 126: 159-177 (in Swedish).
https://doi.org/10.1016/j.ejca.2019.11.015 DOI: https://doi.org/10.1016/j.ejca.2019.11.015
Carli P, de Giorgi V, Palli D, Giannotti V, Giannotti B. Preoperative assessment of melanoma thickness by ABCD score of dermatoscopy. J Am Acad Dermatol 2000; 43: 459-466.
https://doi.org/10.1067/mjd.2000.106518 DOI: https://doi.org/10.1067/mjd.2000.106518
Tan E, Oakley A, Soyer HP, Haskett M, Marghoob A, Jameson M, et al. Interobserver variability of teledermoscopy: an international study. Br J Dermatol 2010; 163: 1276-1281.
https://doi.org/10.1111/j.1365-2133.2010.10010.x DOI: https://doi.org/10.1111/j.1365-2133.2010.10010.x
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