Integrating static and dynamic features of melanoma: The DynaMel algorithm - 16/12/11
Abstract |
Background |
Sequential digital dermatoscopy identifies dynamic changes in melanocytic lesions. However, no algorithm exists that systematically weights dynamic changes regarding their association with melanoma.
Objective |
We sought to identify relevant dynamic changes and to integrate these into a novel diagnostic algorithm.
Methods |
During follow-up (mean 44.28 months) of 688 patients at high risk, 675 pigmented lesions with prospectively documented dynamic changes were excised. The association between specific changes and melanoma was assessed.
Results |
We detected 61 melanomas (38 invasive, median thickness 0.42 mm) with dynamic changes. Multivariate logistic regression analyses revealed a significant association between the diagnosis of melanoma and 5 dynamic criteria. According to the observed odds ratios we defined two dynamic major criteria (2 points each: asymmetric-multifocal enlargement and architectural change) and 3 dynamic minor criteria (1 point each: focal increase in pigmentation, focal decrease in pigmentation, and overall decrease in pigmentation when not accompanied by a lighter pigmentation of the adjacent skin). The DynaMel score was generated by addition of dynamic and 7-point checklist scores with a threshold for excision of 3 or more points. Including information about dynamic changes increased the sensitivity of the 7-point checklist from 47.5% (29 of 61 melanomas detected) to 77.1% (47 of 61 melanomas detected). The specificity slightly decreased from 99.0% to 98.1%.
Limitations |
Before broad application the DynaMel algorithm needs to be validated using data from a different prospective study.
Conclusions |
The DynaMel algorithm integrates a scoring system for dynamic dermatoscopic changes into the 7-point checklist for dermatoscopy and thereby increased the sensitivity of melanoma detection.
Le texte complet de cet article est disponible en PDF.Key words : digital dermatoscopy, DynaMel, dynamic changes, melanoma, nevi
Abbreviations used : CI, OR, ROC
Plan
The first two authors contributed equally to this work. |
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Supported in part by the Niedersächsische Krebsgesellschaft e.V., Hannover, Germany. The FotoFinder dermoscope used in this study is a donation of Teachscreen Software GmbH (Bad Birnbach, Germany) to the University Hospital Göttingen. |
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Conflicts of interest: None declared. |
Vol 66 - N° 1
P. 27-36 - janvier 2012 Retour au numéroBienvenue sur EM-consulte, la référence des professionnels de santé.
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