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A new dermoscopic algorithm for the differential diagnosis of facial lentigo maligna and pigmented actinic keratosis

  • Clinical Report
  • Published:
European Journal of Dermatology

Abstract

Background

The clinical and dermoscopic diagnosis of facial lentigo maligna (LM) and pigmented actinic keratosis (PAK) remains challenging, particularly at the early disease stages.

Objectives

To identify dermoscopic criteria that might be useful to differentiate LM from PAK, and to elaborate and validate an automated diagnostic algorithm for facial LM/PAK.

Materials & Methods

We performed a retrospective multicentre study to evaluate dermoscopic images of histologically-proven LM and PAK, and assess previously described dermoscopic criteria.

Results

In the first part of the study, 61 cases of LM and 74 PAK were examined and a parsimonious algorithm was elaborated using stepwise discriminant analysis. The following eight dermoscopic criteria achieved the greatest discriminative power: (1) light brown colour; (2) a structureless zone, varying in colour from brown to brown/tan, to black; (3) in-focus, discontinuous brown lines; (4) incomplete brown or grey circles; (5) a structureless brown or black zone, obscuring the hair follicles; (6) a brown (tan), eccentric, structureless zone; (7) a blue structureless zone; and (8) scales. The newly developed algorithm was subsequently validated using an additional series of 110LMand 75 PAKcases. Diagnostic accuracy was 86.5% (k: 0.73, 95% CI: 0.63-0.83). For the diagnosis of LM vs PAK, sensitivity was 82.7% (95% CI: 75.7-89.8%), specificity was 92.0% (95% CI: 85.9-98.1%), positive predictive value was 93.8% (95% CI: 89.0-98.6%), and negative predictive value was 78.4% (95% CI: 68.4-86.5%).

Conclusions

This algorithm may represent an additional tool for clinicians to distinguish between facial LM and PAK.

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Authors and Affiliations

  1. Department of Dermatology, University of L’Aquila, L’Aquila, Italy

    Tamara Micantonio, Ambra Antonini & Maria Concetta Fargnoli

  2. Department of Community and Clinical Sciences, University of Milan, Milan, Italy

    Luca Neri

  3. Skin Cancer Unit, Arcispedale S. Maria Nuova-IRCCS, Reggio Emilia, Italy

    Caterina Longo

  4. Institute of Dermatology, Catholic University of Rome, Rome, Italy

    Simone Grassi, Alessandro Di Stefani, Valeria Coco & Ketty Peris

  5. Dermatology Unit, Second University of Naples, Naples, Italy

    Giuseppe Argenziano

Authors
  1. Tamara Micantonio
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  2. Luca Neri
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  3. Caterina Longo
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  4. Simone Grassi
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  5. Alessandro Di Stefani
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  6. Ambra Antonini
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  7. Valeria Coco
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  8. Maria Concetta Fargnoli
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  9. Giuseppe Argenziano
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  10. Ketty Peris
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Corresponding author

Correspondence to Ketty Peris.

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Micantonio, T., Neri, L., Longo, C. et al. A new dermoscopic algorithm for the differential diagnosis of facial lentigo maligna and pigmented actinic keratosis. Eur J Dermatol 28, 162–168 (2018). https://doi.org/10.1684/ejd.2018.3246

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  • DOI: https://doi.org/10.1684/ejd.2018.3246

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