Dermoscopic evaluation of nodular melanoma

Scott W. Menzies, Fergal J. Moloney, Karen Byth, Michelle Avramidis, Giuseppe Argenziano, Iris Zalaudek, Ralph P. Braun, Josep Malvehy, Susana Puig, Harold S. Rabinovitz, Margaret Oliviero, Horacio Cabo, Riccardo Bono, Maria A. Pizzichetta, Magdalena Claeson, Daniel C. Gaffney, H. Peter Soyer, Ignazio Stanganelli, Richard A. Scolyer, Pascale GuiteraJohn Kelly, Olivia McCurdy, Alex Llambrich, Ashfaq A. Marghoob, Pedro Zaballos, Herbert M. Kirchesch, Domenico Piccolo, Jonathan Bowling, Luc Thomas, Karin Terstappen, Masaru Tanaka, Giovanni Pellacani, Gianluca Pagnanelli, Giovanni Ghigliotti, Blanca Carlos Ortega, Greg Crafter, Ana María Perusquía Ortiz, Isabelle Tromme, Isil Kilinc Karaarslan, Fezal Ozdemir, Anthony Tam, Christian Landi, Peter Norton, Nida Kaçar, Lidia Rudnicka, Monika Slowinska, Olga Simionescu, Alessandro Di Stefani, Elliot Coates, Juergen Kreusch

Research output: Contribution to journalArticlepeer-review

76 Scopus citations


Importance: Nodular melanoma (NM) is a rapidly progressing potentially lethal skin tumor for which early diagnosis is critical. Objective: To determine the dermoscopy features of NM. Design: Eighty-three cases of NM, 134 of invasive non- NM, 115 of nodular benign melanocytic tumors, and 135 of nodular nonmelanocytic tumors were scored for dermoscopy features using modified and previously described methods. Lesions were separated into amelanotic/ hypomelanotic or pigmented to assess outcomes. Setting: Predominantly hospital-based clinics from 5 continents. Main Outcome Measures: Sensitivity, specificity, and odds ratios for features/models for the diagnosis of melanoma. Results: Nodular melanoma occurred more frequently as amelanotic/hypomelanotic (37.3%) than did invasive non-NM (7.5%). Pigmented NM had a more frequent (compared with invasive non-NM; in descending order of odds ratio) symmetrical pigmentation pattern (5.8% vs 0.8%), large-diameter vessels, areas of homogeneous blue pigmentation, symmetrical shape, predominant peripheral vessels, blue-white veil, pink color, black color, and milky red/pink areas. Pigmented NM less frequently displayed an atypical broadened network, pigment network or pseudonetwork, multiple blue-gray dots, scarlike depigmentation, irregularly distributed and sized brown dots and globules, tan color, irregularly shaped depigmentation, and irregularly distributed and sized dots and globules of any color. The most important positive correlating features of pigmented NM vs nodular nonmelanoma were peripheral black dots/globules, multiple brown dots, irregular black dots/globules, bluewhite veil, homogeneous blue pigmentation, 5 to 6 colors, and black color. A model to classify a lesion as melanocytic gave a high sensitivity (98.0%) for both nodular pigmented and nonnodular pigmented melanoma but a lower sensitivity for amelanotic/ hypomelanoticNM(84%). A method for diagnosing amelanotic/hypomelanotic malignant lesions (including basal cell carcinoma) gave a 93% sensitivity and 70% specificity for NM. Conclusions and Relevance: When a progressively growing, symmetrically patterned melanocytic nodule is identified, NM needs to be excluded.

Original languageEnglish (US)
Pages (from-to)699-709
Number of pages11
JournalJAMA Dermatology
Issue number6
StatePublished - Jun 2013
Externally publishedYes

ASJC Scopus subject areas

  • Dermatology


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