Borsari S, Peccerillo F, Pampena R, Lai M, Spadafora M, Moscarella E, Lallas A, Pizzichetta M A, Zalaudek I, Del Regno L, Peris K, Pellacani G, Longo C
Centro Oncologico ad Alta Tecnologia Diagnostica, Azienda Unità Sanitaria Locale - IRCCS di Reggio Emilia, Reggio Emilia, Italy.
Department of Dermatology, University of Modena and Reggio Emilia, Modena, Italy.
J Eur Acad Dermatol Venereol. 2020 Dec;34(12):2802-2808. doi: 10.1111/jdv.16604. Epub 2020 Jun 5.
Melanocytic lesions with eccentric hyperpigmentation (EH), even though without other dermatoscopic features of melanoma, are often excised.
Aiming to understand whether the EH in a pigmented lesion is an accurate criterion of malignancy, we evaluated the capability of two evaluators, with different expertise, to correctly diagnose a melanoma when analysing a given lesion in toto versus a partial analysis, with only the EH or the non-hyperpigmented portion (non-EH) visible.
Dermatoscopic images of 240 lesions (107 melanomas and 133 nevi) typified by EH were selected. Facial, acral, mucosal lesions and lesions showing clear-cut features of melanoma (except for atypical network) were excluded. Clinical and dermoscopic features (main pattern and numbers of colours) were described for all cases. Each image was split in two through a software so that only the EH or the non-EH was visible. Two blinded evaluators examined three sets of images, two with customized images and one with the non-modified ones: they were asked to give a dichotomous diagnosis (melanoma or nevus) for each image.
Melanomas were significantly more frequently typified by colour variegation (3 colours in 44.8% and 4 colours in 41.1% of cases) and atypical network (88.1% in the EH). No significant differences in diagnostic accuracy emerged between the two evaluators. Sensitivity improved in the evaluation of the whole lesions (mean sensitivity 89.7%) in comparison with the evaluation of EH or non-EH alone (72.7-62.6%). Specificity increased when evaluating the EH (54.1%). Positive predictive value (PPV) and likelihood ratio (LR+) of EH resulted 52.3% and 1.4, meaning that in one case out of two with EH is a melanoma.
Lesions with EH are challenging, regardless of dermoscopic experience. The EH is a robust criterion for malignancy, since the evaluation of the whole lesion, through an intralesional comparative approach, increases sensitivity.
具有偏心性色素沉着（EH）的黑素细胞性病变，即使没有黑色素瘤的其他皮肤镜特征，也常常被切除。
为了了解色素性病变中的EH是否是恶性肿瘤的准确标准，我们评估了两名具有不同专业知识的评估者在对给定病变进行整体分析与仅分析可见的EH或非色素沉着部分（非EH）的部分分析时正确诊断黑色素瘤的能力。
选择了240例以EH为特征的病变（107例黑色素瘤和133例痣）的皮肤镜图像。排除面部、肢端、黏膜病变以及具有明确黑色素瘤特征（非典型网络除外）的病变。描述了所有病例的临床和皮肤镜特征（主要模式和颜色数量）。通过软件将每张图像一分为二，以便仅可见EH或非EH。两名盲法评估者检查了三组图像，两组为定制图像，一组为未修改图像：要求他们对每张图像给出二分诊断（黑色素瘤或痣）。
黑色素瘤更常见的特征是颜色斑驳（44.8%的病例有3种颜色，41.1%的病例有4种颜色）和非典型网络（EH中为88.1%）。两名评估者之间的诊断准确性没有显著差异。与单独评估EH或非EH相比，评估整个病变时敏感性有所提高（平均敏感性89.7%），单独评估EH或非EH时敏感性为72.7%-62.6%。评估EH时特异性增加（54.1%）。EH的阳性预测值（PPV）和似然比（LR+）分别为52.3%和1.4，这意味着每两例有EH的病例中就有一例是黑色素瘤。
无论皮肤镜经验如何，具有EH的病变都具有挑战性。EH是恶性肿瘤的一个可靠标准，因为通过病灶内比较方法评估整个病变可提高敏感性。
