Diagnostic Accuracy of Dermoscopy for Spitzoid Tumours in Adults.
In a retrospective adult cohort, dermoscopy showed high sensitivity, specificity, and negative predictive value but low positive predictive value for histopathologically defined spitzoid tumours, while certain vascular patterns were associated with malignancy.
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In a retrospective adult cohort, dermoscopy showed high sensitivity, specificity, and negative predictive value but low positive predictive value for histopathologically defined spitzoid tumours, while certain vascular patterns were associated with malignancy.
Research significance
Evidence: dermoscopic patterns may help identify or exclude spitzoid tumours and flag adult lesions requiring heightened suspicion and biopsy. Inference: improved diagnostic triage could reduce delayed melanoma diagnosis or unnecessary procedures, but the record provides no evidence of treatment selection, reduced toxicity, or improved clinical outcomes, and pediatric applicability is unestablished.
Source abstract
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.