Diagnostic Accuracy of Dermoscopy for Spitzoid Tumours in Adults
DOI:
https://doi.org/10.2340/actadv.v106.adv-2026-0513Keywords:
dermoscopy, melanoma, sensitivity and specificity, spitz nevus, spitzoid-lookingAbstract
Spitzoid tumours (ST) represent a diagnostic chal-lenge and the accuracy of dermoscopy in these cases remains unclear. This retrospective study evaluated dermoscopic images collected from 2011 to 2016. Two dermatologists, blinded to clinical/ histopathological data, identified lesions with spitzoid dermoscopic patterns, using histopathology as the gold standard. Of 4,337 dermoscopic images, 240 (5.5%) showed spitzoid dermoscopic patterns (221 patients; median age 40; 57.9 % female). Histopathology revealed 23 % (55/240) ST, 62 % (149/240) non--spitzoid melanocytic lesions and 15 % (36/240) non--melanocytic lesions. Overall, 25.4 % (61/240) were malignant, mainly melanoma/melanoma metastases (50/240). Across excised tumours, 1.5 % (67/4,337) were ST. Sensitivity and specificity were 82.1 % (95% CI 70.8%–90.4%) and 95.7 % (95% CI 95%–96.3%), with an AUC of 0.88 (95% CI 0.84–0.93). Positive predictive value (PPV) was 22.9 % (95% CI 17.8%–28.8%), and nega-tive predictive value (NPV) was 99.7 % (95% CI 99.5%–99.9%). Starburst pattern was more frequent in ST (p=0.007). Linear vessels (OR 5.12; 95% CI 2.08–13.1) and glomerular vessels (OR 3.03; 95% CI 1.37–6.69) correlated with malignancy. Dermoscopy demonstrated high diagnostic accuracy and NPVnegative predictive value. However, low PPVpositive predictive value highlights limited specificity in adults; since one1 in four4 lesions with a spitzoid dermoscopic pattern was malignant, any spitzoid lesion in adults warrants high clinical suspicion.
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