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7-Point Checklist
[Argenziano et al. Arch Dermatol 1998]


Additional diagnostic algorithm developed for simplifying the classic pattern analysis

  1. Low number of features to identify

  2. Scoring diagnostic system

 

Consensus Meeting (1990)

 

7-Point Checklist (1998)

  1. Discrete Pigment Network

  2. Prominent PN

  3. Regular PN

  4. Irregular PN

  5. Wide PN

  6. Narrow PN

  7. Broad PN

  8. Delicate PN

  1. Atypical Pigment Network
  1. Pseudopods

  2. Radial streaming

2. Irregular Streaks
  1. Brown globules

  2. Black dots

3. Irregular Dots/globules
  1. Whitish veil
4. Blue - whitish veil
  1. White scarlike areas
  2. Gray - blue areas
5. Regression Structures
  1. Hypopigmented areas 
    (not siginificant)
  2. Reticular depigmentation 
    (not significant)
  (ADDITIONAL CRITERIA)
  1. Milia-like cysts
  2. Comedo-like openings
  3. Telangiectasia
  4. Red-blue areas
  5. Maple leaf-like areas

Criteria for
non-melanocytic
lesions

6. Irregular Pigmentation
7. Atypical Vascular Pattern

 

7-Point Scored Diagnosis

 

  • Odds ratios of each of the 7 criteria were calculated by multivariate analysis.

  • 7-point score of 2 was given to the 3 criteria with odds ratios more than 5, and a score of 1 was given to the 4 criteria with odds ratios less than 5.

  • By simple addition of the individual scores a minimum total score of 3 is required for the diagnosis of melanoma, whereas a total score of less than 3 is indicative of a non-melanoma.

 

7-Point Checklist: Definition and Histopathologic Correlates of the 7 Melanoma-Specific Dermoscopic Criteria

 

Criterion

Definition

Histopathologic correlates

1. Atypical pigment network

Black, brown, or gray network with irregular meshes and thick lines Irregular and broadened rete ridges

2. Blue-whitish veil

Irregular, confluent, gray-blue to whitish-blue diffuse pigmentation Acanthotic epidermis with focal hypergranulosis above sheets of heavily pigmented melanocytes in the dermis

3. Atypical vascular pattern

Linear-irregular or dotted vessels not clearly combined with regression structures Neovascularization

4. Irregular streaks

Irregular, more or less confluent, linear structures not clearly combined with pigment network lines Confluent junctional nests of melanocytes

5. Irregular pigmentation

Black, brown, and/or gray pigmented areas with irregular shape and/or distribution
Hyperpigmentation throughout the epidermis and/or upper dermis

6. Irregular dots/globules

Black, brown, and/or gray round to oval, variously sized structures irregularly distributed within the lesion
Pigment aggregates within stratum corneum, epidermis, dermo-epidermal junction, or papillary dermis

7. Regression structures

White areas (white scarlike areas) and blue areas (gray-blue areas, peppering, multiple blue-gray dots) may be associated, thus featuring so-called blue-whitish areas virtually indistinguishable from blue-whitish veil Thickned papillary dermis with fibrosis and/or variable amounts of melanophages

 

 

7-Point Checklist. A minimum total score of 3 is required for the diagnosis of melanoma

 

ELM criterion

Odds ratioa

7-point scoreb

Major criteria:
1. Atypical pigment network
5.19 2
2. Blue-whitish veil 11.1 2
3. Atypical vascular pattern 7.42 2
Minor criteria:
4. Irregular streaks
3.01 1
5. Irregular pigmentation 4.90 1
6. Irregular dots/globules 2.93 1
7. Regression structures 3.89 1
a Odds ratios measuring the capacity of each criterion to increase the probability of melanoma diagnosis.
b The score for a given criterion is determined on the basis of the odds ratio: >5 (score = 2), and <5 (score = 1).

 

Simply add the scores of each criterion that is present within a pigmented lesion.

 

Melanoma:
7point score = 7

 

Melanoma:
7point score = 3

 

Clark nevus:
7point score = 1

 

Melanoma:
7point score = 6

 

Melanoma:
7point score = 5

 

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