Dermoscopy structures as predictors of sentinel lymph node positivity in cutaneous melanoma

• Published in: British journal of dermatology (1951) Vol. 172; no. 5; pp. 1269 - 1277
• Main Authors: González-Álvarez, T., Carrera, C., Bennassar, A., Vilalta, A., Rull, R., Alos, L., Palou, J., Vidal-Sicart, S., Malvehy, J., Puig, S.
• Format: Journal Article
• Language: English
• Published: England Blackwell Publishing Ltd 01.05.2015
• Subjects: Dermoscopy - methods; Dermoscopy - standards; Female; Humans; Male; Melanoma - pathology; Middle Aged; Neoplasm Staging; Retrospective Studies; Sensitivity and Specificity; Sentinel Lymph Node Biopsy; Skin Neoplasms - pathology
• ISSN: 0007-0963; 1365-2133
• DOI: 10.1111/bjd.13552

Summary Background Histological features such as Breslow thickness, ulceration and mitosis are the main criteria to guide sentinel lymph node biopsy (SLNB) in melanoma. Dermoscopy may add complementary information to these criteria. Objectives To evaluate the correlation between dermoscopy structures and SLNB positivity. Methods Retrospective analysis of 123 consecutive melanomas with Breslow thickness > 0·75 mm, SLNB performed during follow‐up and dermoscopic images. Results Men were more likely to have a positive SLNB. The presence of ulceration and blotch and the absence of a pigmented network in dermoscopy correlated with positive SLNB. Histological ulceration also correlated with positive SLNB. A dermoscopy SCORE predicted SLN status with a sensitivity of 96·3% and a specificity of 30·2%. When sex and Breslow thickness were added (SCOREBRESEX), the sensitivity remained at 96·3% but the specificity increased to 52·1%. This study is limited by the number of patients and was performed in only one institution. Conclusions Dermoscopy allowed a more precise prediction of SLN status. If a combined SCOREBRESEX was used to select patients for SLNB, 41·5% of procedures might be avoided. What's already known about this topic? There is a good correlation between some dermoscopic criteria and histopathology in melanoma. Dermoscopy is a method proposed for the preoperative evaluation of melanoma thickness. What does this study add? Dermoscopy can reduce sentinel lymph node biopsy procedures by 41·5%. The presence of an atypical pigmented network correlates with a negative sentinel lymph node. Dermoscopic ulceration and the presence of blotch correlated strongly with a positive sentinel lymph node.