Clinical, Dermoscopic and Histopathologic Correlation in Melanocytic Nevi

Öz

Dermoscopy is a noninvasive technique that facilitates the diagnosis of melanocytic nevus (MN). Different algorithms are used in the differential diagnosis of melanocytic lesions. In this study, we aimed to correlate the sensitivity and specificity of the ABCD rule, 7 point control list and pattern analysis in MN. A total of 60 MNs of 38 patients who applied to dermatology outpatient clinic have been evaluated. Hand dermatoscopy (Dermatoscope Delta 10) and digital dermatoscope (MoleMax II) were used for dermoscopic examination, and  each of the dermoscopic images were assessed with the pattern analysis, the 7 point checklist and the ABCD rule. After dermoscopic examination, lesions were examined histopathologically following excisional or punch biopsy. The concordance between dermoscopic and histopathologic diagnosis were evaluated. In our study, the sensitivities of ABCD rule, 7 point control list and pattern analysis were 94.6%, 92.9% and 97.5% respectively. The specificities were 78.3%,  85% and 95% respectively. According to our study, pattern analysis method had the highest specificity and sensitivity.  

Melanositik Nevuslarda Klinik, Dermoskopik ve Histopatolojik Korelasyon

Öz

Dermoskopi, melanositik nevuslara (MN) tanı konmasını kolaylaştıran noninvazif bir tekniktir. Melanositik lezyonların ayırıcı tanısında farklı algoritmalar kullanılmaktadır. Bu çalışmada MN’larda ABCD kuralı, 7 nokta kontrol listesi ve patern analizinin duyarlılık, özgüllük ve tanısal doğruluklarının korelasyonu amaçlanmıştır. Çalışmamızda dermatoloji polikliniğine başvuran 38 hastaya ait toplam 60  MN klinik, dermoskopik ve histopatolojik olarak değerlendirilmiştir. Dermoskopik muayenede el dermoskopu (Dermatoskop Delta 10) ve digital dermoskop (MoleMax II) kullanılmış; her bir lezyon ABCD kuralı, 7 nokta kontrol listesi ve patern analizine göre skorlanmıştır. Dermoskopik muayene sonrası lezyonlar eksizyon veya punch biyopsi ile alınarak histopatolojik olarak incelenmiş; dermoskopik ve histopatolojik tanıların uyumluluğu değerlendirilmiştir. Çalışmamızda ABCD kuralının, 7 nokta kontrol listesinin ve patern analizinin duyarlılıkları  sırasıyla %94.6, %92.9 ve %97.5 olarak saptanırken;  özgüllükleri ise sırasıyla %78.3,  %85  %95 olarak bulunmuştur. Çalışmamıza göre melanositik lezyonların patern analizi yöntemi en yüksek özgüllük ve duyarlılılığa sahiptir. 

Anahtar Kelimeler

• Dermoskopi,ABCD kuralı,7 nokta kontrol listesi,patern analizi,Histopatoloji

Kaynakça

1. 1. Wolff K, Goldsmith LA, Katz SI, Gilchrest BA, Paller AS, Leffell DJ. Fitzpatrick’s dermatology in general medicine. 7th ed. New York: McGraw-Hill; 2007.
2. 2. Anadolu R, Akay BN. Melanomun dermoskopik bulguları. İç: Tüzün Y, editör, Dermatolojide Gelişmeler-6. İstanbul:Acamedia; 2007.s.76-85.
3. 3. Pehamberger H, Steiner A, Wolff K. In vivo epiluminescence microscopy of pigmented skin lesions. I. Pattern analysis of pigmented skin lesions. J Am Acad Dermatol 1987;17:571-83.
4. 4. Nachbar F, Stolz W, Merkle T, et al. The ABCD rule of dermatoscopy. High prospective value in the diagnosis of doubtful melanocytic skin lesions. J Am Acad Dermatol 1994;30:551-9.
5. 5. Stolz W, Riemann A, Cognetta AB, Braun-Falco O. ABCD rule of dermatoscopy: a new practical method for early recognition of malignant melanoma. Eur J Dermatol. 1994;4:521-7.
6. 6. Argenziano G, Fabbrocini G, Carli P, et al. Epiluminescence microscopy for the diagnosis of doubtful melanocytic skin lesions: comparison of the ABCD rule of dermatoscopy and a new 7-point checklist based on pattern analysis. Arch Dermatol. 1998;134:1563-70.
7. 7. Rabinovitz HS, Barnhill RL. Benign Melanocytic Neoplasms. In: Bolognia JL, Jorizzo JL, Schaffer JV, editors. Dermatology. 3rd edn. St. Louis: Mosby Elsevier; 2012, p. 1861-1863.
8. 8. Rabinovitz HS, Barnhill RL. Benign Melanocytic Neoplasms. In: Bolognia JL, Jorizzo JL, Schaffer JV, editors. Dermatology. 3rd edn. St. Louis: Mosby Elsevier; 2012, p. 1868-1871.

9. 9. Carli P, de Giorgi V, Chiarugi A, et al. Addition of dermoscopy to conventional naked-eye examination in melanoma screening: a randomized study. J Am Acad Dermatol 2004;50:683-9.
10. 10. Steiner A, Pehamberger H, Wolff K. In vivo epiluminescence microscopy of pigmented skin lesions. II. Diagnosis of small pigmented skin lesions and early detection of malignant melanoma. J Am Acad Dermatol 1987;17:584-91.
11. 11. Steiner A, Pehamberger H, Wolff K. Improvement of the diagnostic accuracy in pigmented skin lesions by epiluminescent light microscopy. Anticancer Res 1987;7:433-4.
12. 12. Blum A, Rassner G, Garbe C. Modified ABC-point list of dermoscopy: A simplified and highly accurate dermoscopic algorithm for the diagnosis of cutaneous melanocytic lesions. J Am Acad Dermatol 2003;48:672-8.
13. 13. Annessi G, Bono R, Sampogna F, Faraggiana T, Abeni D. Sensitivity, specificity, and diagnostic accuracy of three dermoscopic algorithmic methods in the diagnosis of doubtful melanocytic lesions: the importance of light brown structureless areas in differentiating atypical melanocytic nevi from thin melanomas. J Am Acad Dermatol 2007;56:759-67.
14. 14. Şahin MT, Ermertcan AT, İnanır Işıl, Demir MA, Öztürkcan S. Nevus Nevosellularislerde Dermoskopik ve Histopatolojik Tanıların Karşılaştırılması. ADÜ Tıp Fakültesi Dergisi 2004;5:19-22.
15. 15. Hofmann-Wellenhof R, Blum A, Wolf IH, et al. Dermoscopic classification of Clark's nevi (atypical melanocytic nevi). Clin Dermatol 2002;20:255-8.
16. 16. Özdemir F, Ünal İ, Ceylan C, Ertam İ. Bölgemizde görülen Clark nevusların dermoskopik klasifikasyonu. Türkderm 2001;35:300-6.
17. 17. Morales-Callaghan AM, Castrodeza-Sanz J, Martínez-García G, Peral-Martínez I, Miranda-Romeroa A. Correlation between clinical, dermatoscopic and histopathologic variables in atypical melanocytic nevi. Actas Dermosifiliogr 2008;99:380-9.
18. 18. Carli P, De Giorgi V, Massi D, Giannotti B. The role of pattern analysis and the ABCD rule of dermoscopy in the detection of histological atypia in melanocytic naevi. Br J Dermatol 2000;143:290-7.
19. 19. Steiner A, Binder M, Schemper M, Wolff K, Pehamberger H. Statistical evaluation of epiluminescence microscopy criteria for melanocytic pigmented skin lesions. J Am Acad Dermatol 1993;29:581-8.
20. 20. Friedman RJ, Farber MJ, Warycha MA, Papathasis N, Miller MK, Heilman ER. The "dysplastic" nevus. Clinics in Dermatol 2009;27:103-15.
21. 21. Roesch A, Burgdorf W, Stolz W, et al. Dermatoscopy of "dysplastic nevi": a beacon in diagnostic darkness. Eur J Dermatol 2006;16:479-93.