Department of Dermatology, Georg August University Göttingen, Von Siebold Strasse 3, D 37075 Göttingen, Germany.
J Am Acad Dermatol. 2010 May;62(5):785-93. doi: 10.1016/j.jaad.2009.08.049. Epub 2010 Mar 11.
The retrospectively developed 7-point checklist is one of the most applicable dermatoscopic algorithms for clinical use. However, until today no prospective data on the diagnostic performance of this algorithm were reported.
Our aim was to assess the sensitivity, specificity, and diagnostic accuracy of the 7-point checklist in the setting of a prospective long-term study.
Patients at increased melanoma risk (n = 688) were screened at regular intervals by naked-eye examination, the dermatoscopic 7-point checklist, and digital dermatoscopy follow-up (10-year study interval).
We detected 127 melanomas including 50 melanomas in situ. The mean Breslow thickness of invasive melanomas was 0.57 mm. A total of 79 melanomas displayed the 7-point checklist melanoma threshold of 3 or more points (62% sensitivity, compared with 78%-95% in retrospective settings). In all, 48 melanomas scored fewer than 3 points and were excised because of complementary information (eg, lesional history, dynamic changes detected by digital dermatoscopy). The specificity of the 7-point checklist was 97% (compared with 65%-87% in retrospective settings). Regression patterns, atypical vascular patterns, and radial streaming were associated with the highest relative risk for melanoma (odds ratio 3.26, 95% confidence interval 2.05-5.16; odds ratio 3.04, 95% confidence interval 1.70-5.46; odds ratio 2.91, 95% confidence interval 1.64-5.15; P < .0003, respectively). Melanomas thicker than 0.5 mm exhibited significantly more regression patterns and atypical vascular patterns (P < .02). The malignant versus benign ratio for all excised lesions was 1:8.6 (127 melanomas, 1092 nonmelanomas).
Calculation of the specificity was a limitation. True negative lesions were defined by a score less than 3 points and either the histopathological diagnosis of nonmelanoma or the absence of dynamic changes during digital dermatoscopy follow-up (nonexcised, nonsuspicious, no change).
The 7-point checklist for dermatoscopy was less sensitive but highly specific in this prospective clinical setting. Complementary information clearly increased the sensitivity. Regression patterns or radial streaming in nevi of patients at high risk should raise a higher melanoma suspicion than might be concluded from retrospective studies.
回顾性开发的七点检查表是最适用于临床应用的皮肤科算法之一。然而，直到今天，还没有关于该算法诊断性能的前瞻性数据报告。
我们的目的是在前瞻性长期研究中评估七点检查表的敏感性、特异性和诊断准确性。
对高风险黑色素瘤患者（n=688）进行定期裸眼检查、皮肤科七点检查表和数字皮肤科随访（10 年研究间隔）。
我们共发现 127 例黑色素瘤，其中包括 50 例原位黑色素瘤。浸润性黑色素瘤的平均 Breslow 厚度为 0.57mm。共有 79 例黑色素瘤的七点检查表阈值达到 3 分或以上（62%的敏感性，与回顾性研究中的 78%-95%相比）。共有 48 例黑色素瘤的评分低于 3 分，因补充信息（例如病变史、数字皮肤科随访中检测到的动态变化）而被切除。七点检查表的特异性为 97%（与回顾性研究中的 65%-87%相比）。回归模式、非典型血管模式和放射状流与黑色素瘤的最高相对风险相关（优势比 3.26，95%置信区间 2.05-5.16；优势比 3.04，95%置信区间 1.70-5.46；优势比 2.91，95%置信区间 1.64-5.15；P<0.0003）。厚度大于 0.5mm 的黑色素瘤表现出更多的回归模式和非典型血管模式（P<0.02）。所有切除病变的恶性与良性比例为 1:8.6（127 例黑色素瘤，1092 例非黑色素瘤）。
特异性的计算是一个局限性。阴性真病变的定义是评分小于 3 分，且组织病理学诊断为非黑色素瘤或数字皮肤科随访期间无动态变化（未切除、非可疑、无变化）。
在这种前瞻性临床环境中，皮肤科七点检查表的敏感性较低，但特异性较高。补充信息明显提高了敏感性。高危患者的痣中出现回归模式或放射状流应比回顾性研究得出的黑色素瘤怀疑更高。
