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< CNMD \ <Tutorial
\<Second step \ 7-point checklist
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7-Point Checklist
[Argenziano et al. Arch Dermatol 1998]
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Additional diagnostic algorithm developed for simplifying the classic pattern analysis
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Low number of features to identify
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Scoring diagnostic system
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Consensus Meeting (1990)
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7-Point Checklist (1998)
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Discrete Pigment Network
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Prominent PN
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Regular PN
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Irregular PN
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Wide PN
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Narrow PN
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Broad PN
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Delicate PN
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1. Atypical Pigment Network |
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Pseudopods
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Radial streaming
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2. Irregular Streaks |
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Brown globules
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Black dots
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3. Irregular
Dots/globules |
- Whitish veil
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4. Blue - whitish veil |
- White scarlike areas
- Gray - blue areas
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5. Regression Structures |
- Hypopigmented areas
(not siginificant)
- Reticular depigmentation
(not significant)
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(ADDITIONAL CRITERIA) |
- Milia-like cysts
- Comedo-like openings
- Telangiectasia
- Red-blue areas
- Maple leaf-like areas
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Criteria for
non-melanocytic
lesions
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6. Irregular Pigmentation
7. Atypical Vascular Pattern |
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7-Point Scored Diagnosis
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Odds ratios of each of the 7 criteria were calculated by multivariate
analysis.
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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.
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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.
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7-Point Checklist:
Definition and Histopathologic Correlates of the 7 Melanoma-Specific Dermoscopic Criteria
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Criterion
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Definition
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Histopathologic correlates
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1. Atypical pigment network
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Black,
brown, or gray network with irregular meshes and thick lines |
Irregular and broadened rete ridges |
2. Blue-whitish veil
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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
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Linear-irregular or dotted vessels not clearly combined with regression structures |
Neovascularization |
4. Irregular streaks
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Irregular, more or less
confluent, linear structures not clearly combined with pigment network lines |
Confluent junctional nests of melanocytes |
5. Irregular pigmentation
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Black,
brown, and/or gray pigmented areas with irregular shape and/or distribution
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Hyperpigmentation throughout the epidermis and/or upper dermis
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6. Irregular dots/globules
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Black,
brown, and/or gray round to oval, variously sized structures irregularly distributed within the lesion
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Pigment aggregates within stratum
corneum, epidermis, dermo-epidermal junction, or papillary dermis
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7. Regression structures
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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
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7-Point Checklist. A minimum total score of 3 is required for the diagnosis of melanoma
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ELM criterion
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Odds ratioa
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7-point scoreb
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Major criteria:
1. Atypical pigment network
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5.19 |
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2. Blue-whitish veil
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11.1 |
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3. Atypical vascular pattern
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7.42 |
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Minor criteria:
4. Irregular streaks
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3.01 |
1 |
5. Irregular pigmentation
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4.90
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1
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6. Irregular dots/globules
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2.93
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1
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7. Regression structures
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3.89 |
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a Odds ratios measuring the capacity of each criterion to increase the probability of melanoma
diagnosis.
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b The score for a given criterion is determined on the basis of the odds ratio: >5 (score = 2), and <5 (score = 1).
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Simply add the scores of each criterion that is present within a pigmented
lesion.
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Melanoma:
7point score = 7
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Melanoma:
7point score = 3
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Clark nevus:
7point score = 1
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Melanoma:
7point score = 6
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Melanoma:
7point score = 5
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