General and Oncological Surgery Clinic I, Greater Poland Cancer Centre, Poznań, Poland.
Polish Dermatoscopy Group, Research Workgroup, Poznań, Poland.
Dermatology. 2023;239(6):976-987. doi: 10.1159/000533820. Epub 2023 Sep 4.
Grey perifollicular circles are a dermatoscopic clue to melanoma, especially in facial skin. So far, no other adnexal clues than follicular have been investigated in this diagnosis.
The study aimed to analyse the prevalence of hyperpigmented periadnexal microcircles (HMs) in melanoma and its common simulators at non-facial non-acral sites, analyse the relation between the presence of HM, regression and hypopigmentation, and evaluate the diagnostic accuracy of this structure in melanoma.
International Skin Imaging Collaboration (69,445 images) was searched in April 2020 for the pathology-confirmed dermatoscopic images with metadata including sex, age bin, and declared non-acral non-facial anatomic site. The final study sample (5,408 images, 1,326 of which were melanomas) was evaluated by expert dermatoscopist blinded to the diagnosis and labelled for the presence of ≥3 HM distributed centrally (cHM) or peripherally (pHM), hypopigmentation, and classic dermatoscopic regression structures. A subset of 40 images was labelled by 7 raters (2 residents, 5 experts) to assess interobserver agreement. We compared the presence of pHM with the presence of regression as well as performed a set of independent χ2 tests to evaluate the discriminatory power and its fragility. Performance of the models was assessed using measures of discrimination and calibration.
HM were significantly more prevalent in melanomas than in non-melanomas and nevi. Fair/good interobserver agreement for HM was reached for all the raters, and moderate/good for experts only (single rater/average, respectively). Regardless of regression/hypopigmentation status, pHM were significantly more common in melanoma than in non-melanomas or nevi and were observed significantly more often in melanomas on sun-damaged skin (upper extremity, posterior torso). No significant differences between the groups were found for cHM. pHM proved a high odds ratio in the tests as to the classical indicators such as classic dermatoscopic regression structures.
pHM could be considered a novel dermatoscopic clue to melanoma.
灰色毳毛周围环是黑素瘤的皮肤镜线索，尤其是在面部皮肤。到目前为止，在这种诊断中，除了毛囊之外，还没有其他附属线索被研究过。
本研究旨在分析非面部非肢端部位黑素瘤及常见模拟物中色素性毳毛周围微环（HMs）的患病率，分析 HM 的存在与退行性变和色素减退的关系，并评估该结构在黑素瘤中的诊断准确性。
2020 年 4 月，通过国际皮肤成像协作组织（ISIC），在有病理证实的皮肤镜图像中搜索元数据，包括性别、年龄组和非肢端非面部解剖部位。最终研究样本（5408 张图像，其中 1326 张为黑素瘤）由对诊断结果不知情的专家皮肤科医生进行评估，并标记存在≥3 个中央（cHM）或外周（pHM）分布的 HM、色素减退和经典皮肤镜退行性变结构。40 张图像的子集由 7 名评估者（2 名住院医师，5 名专家）进行标记，以评估观察者间的一致性。我们比较了 pHM 的存在与退行性变的存在，并进行了一系列独立的卡方检验，以评估其鉴别能力及其脆弱性。使用判别和校准的度量来评估模型的性能。
HM 在黑素瘤中的发生率显著高于非黑素瘤和痣。所有评估者对 HM 的观察者间一致性均达到了良好/优秀水平，只有专家达到了中等/良好水平（单一评估者/平均值）。无论退行性变/色素减退状态如何，pHM 在黑素瘤中的发生率均显著高于非黑素瘤或痣，在日光损伤皮肤（上肢、后躯干）上的黑素瘤中更为常见。在经典退行性变结构等指标的检验中，pHM 的比值比均较高。
pHM 可以被认为是黑素瘤的一种新的皮肤镜线索。
