Dermatoscopy of flat pigmented facial lesions

Tschandl, P., Rosendahl, C. and Kittler, H. (2014) Dermatoscopy of flat pigmented facial lesions. Journal of the European Academy of Dermatology and Venereology, 29 1: 120-127. doi:10.1111/jdv.12483

Author Tschandl, P.
Rosendahl, C.
Kittler, H.
Title Dermatoscopy of flat pigmented facial lesions
Journal name Journal of the European Academy of Dermatology and Venereology   Check publisher's open access policy
ISSN 0926-9959
Publication date 2014-03-24
Year available 2014
Sub-type Article (original research)
DOI 10.1111/jdv.12483
Open Access Status
Volume 29
Issue 1
Start page 120
End page 127
Total pages 8
Place of publication Chichester, West Sussex, United Kingdom
Publisher Wiley-Blackwell Publishing
Collection year 2015
Language eng
Formatted abstract
Background: The diagnosis of flat pigmented lesions on the face is challenging because of the morphologic overlap of biologically different lesions and the unknown significance of dermatoscopic patterns.

Objective: To better characterize dermatoscopic patterns of various types of flat pigmented facial lesions and to analyse their significance by calculating their relative risks and diagnostic values.

Methods: We prospectively analysed dermatoscopic images of 240 flat pigmented facial skin lesions collected consecutively from 195 patients (41.5% females, mean age: 61 ± 14 years) between 2007 and March 2012 in a primary skin cancer practice situated in Queensland, Australia.

Results: Histopathologically 114 (47.5%) lesions were malignant (24 lentigo maligna, 21 basal cell carcinomas and 69 pigmented actinic keratoses). Compared with all other patterns the positive predictive value for lentigo maligna was highest for a pattern of circles (31.3%, 95% CI: 11.1-58.6%). A pattern of clods was associated with basal cell carcinoma. If grey structures were present the relative risk for malignancy was 2.2 (95%CI: 1.4-3.4). The best clues to differentiate pigmented actinic keratosis from other lesions were the presence of scale (positive predictive value: 72.2%, specificity: 94.2%), white circles (positive predictive value: 68.8%, specificity: 94.2%) and a sharply demarcated border (positive predictive value: 44.2%, specificity: 86.0%).

Conclusions: In flat lesions a pattern of circles bears the highest risk for facial melanoma but other patterns do not exclude it. Scale, white circles and a sharply demarcated border are clues to pigmented actinic keratoses. The presence of grey colour is a clue to malignancy regardless of pattern.
Q-Index Code C1
Q-Index Status Confirmed Code
Institutional Status UQ
Additional Notes Published online ahead of print 24 March 2014.

Document type: Journal Article
Sub-type: Article (original research)
Collections: Official 2015 Collection
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