Prediction without Pigment: a decision algorithm for non-pigmented skin malignancy

While there are several published comprehensive stepwise algorithmic methods for diagnosing pigmented skin malignancy, only limited material has been published for the stepwise assessment of non-pigmented lesions. We present a method based on pattern analysis, with a stepwise assessment, first, for...

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Autores principales:	Cliff Rosendahl, Alan Cameron, Philipp Tschandl, Agata Bulinska, Harald Kittler, Iris Zalaudek
Formato:	article
Lenguaje:	EN
Publicado:	Mattioli1885 2014
Materias:	dermatoscopy dermoscopy non-pigmented skin cancer algorithm white circles Dermatology RL1-803
Acceso en línea:	https://doaj.org/article/0227a7d62ea84e618498949366b31213
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spelling	oai:doaj.org-article:0227a7d62ea84e618498949366b312132021-11-17T08:32:28ZPrediction without Pigment: a decision algorithm for non-pigmented skin malignancy10.5826/dpc.0401a092160-9381https://doaj.org/article/0227a7d62ea84e618498949366b312132014-01-01T00:00:00Zhttp://dpcj.org/index.php/dpc/article/view/908https://doaj.org/toc/2160-9381 While there are several published comprehensive stepwise algorithmic methods for diagnosing pigmented skin malignancy, only limited material has been published for the stepwise assessment of non-pigmented lesions. We present a method based on pattern analysis, with a stepwise assessment, first, for ulceration, second, for white clues (defined as white lines, or in the case of a raised lesion any of the keratin clues: dermatoscopic white circles, dermatoscopic white structureless areas or surface keratin), and third, if no ulceration or white clues are present, proceed to vessel pattern analysis. This is a novel method, and apart from the assessment of white clues in raised lesions, it has not been formally tested. The priority of keratin clues in raised lesions over vessel pattern analysis has, however, been verified. It is conceded that this method is less specific than methods which have clues of pigmented structures, and accepting these limitations, Prediction without Pigment is a decision algorithm intended to guide the clinician in the decision as to whether to perform a biopsy rather than consistently leading to a specific diagnosis. Reaching a more specific diagnosis at the end of our flowchart can be achieved by weighing of clues both clinical and dermatoscopic, and that ability can be expected to improve with both knowledge and experience, but no diagnostic method, including this one, can be 100% sensitive in diagnosing malignancy, in particular, melanoma. Taking these limitations into account, any non-pigmented lesion, regardless of pattern analysis, which is raised and firm (nodular) and for which a confident, specific benign diagnosis cannot be made, should be excised to exclude the nodular variant of amelanotic melanoma. Cliff RosendahlAlan CameronPhilipp TschandlAgata BulinskaHarald KittlerIris ZalaudekMattioli1885articledermatoscopydermoscopynon-pigmentedskin canceralgorithmwhite circlesDermatologyRL1-803ENDermatology Practical & Conceptual (2014)
institution	DOAJ
collection	DOAJ
language	EN
topic	dermatoscopy dermoscopy non-pigmented skin cancer algorithm white circles Dermatology RL1-803
spellingShingle	dermatoscopy dermoscopy non-pigmented skin cancer algorithm white circles Dermatology RL1-803 Cliff Rosendahl Alan Cameron Philipp Tschandl Agata Bulinska Harald Kittler Iris Zalaudek Prediction without Pigment: a decision algorithm for non-pigmented skin malignancy
description	While there are several published comprehensive stepwise algorithmic methods for diagnosing pigmented skin malignancy, only limited material has been published for the stepwise assessment of non-pigmented lesions. We present a method based on pattern analysis, with a stepwise assessment, first, for ulceration, second, for white clues (defined as white lines, or in the case of a raised lesion any of the keratin clues: dermatoscopic white circles, dermatoscopic white structureless areas or surface keratin), and third, if no ulceration or white clues are present, proceed to vessel pattern analysis. This is a novel method, and apart from the assessment of white clues in raised lesions, it has not been formally tested. The priority of keratin clues in raised lesions over vessel pattern analysis has, however, been verified. It is conceded that this method is less specific than methods which have clues of pigmented structures, and accepting these limitations, Prediction without Pigment is a decision algorithm intended to guide the clinician in the decision as to whether to perform a biopsy rather than consistently leading to a specific diagnosis. Reaching a more specific diagnosis at the end of our flowchart can be achieved by weighing of clues both clinical and dermatoscopic, and that ability can be expected to improve with both knowledge and experience, but no diagnostic method, including this one, can be 100% sensitive in diagnosing malignancy, in particular, melanoma. Taking these limitations into account, any non-pigmented lesion, regardless of pattern analysis, which is raised and firm (nodular) and for which a confident, specific benign diagnosis cannot be made, should be excised to exclude the nodular variant of amelanotic melanoma.
format	article
author	Cliff Rosendahl Alan Cameron Philipp Tschandl Agata Bulinska Harald Kittler Iris Zalaudek
author_facet	Cliff Rosendahl Alan Cameron Philipp Tschandl Agata Bulinska Harald Kittler Iris Zalaudek
author_sort	Cliff Rosendahl
title	Prediction without Pigment: a decision algorithm for non-pigmented skin malignancy
title_short	Prediction without Pigment: a decision algorithm for non-pigmented skin malignancy
title_full	Prediction without Pigment: a decision algorithm for non-pigmented skin malignancy
title_fullStr	Prediction without Pigment: a decision algorithm for non-pigmented skin malignancy
title_full_unstemmed	Prediction without Pigment: a decision algorithm for non-pigmented skin malignancy
title_sort	prediction without pigment: a decision algorithm for non-pigmented skin malignancy
publisher	Mattioli1885
publishDate	2014
url	https://doaj.org/article/0227a7d62ea84e618498949366b31213
work_keys_str_mv	AT cliffrosendahl predictionwithoutpigmentadecisionalgorithmfornonpigmentedskinmalignancy AT alancameron predictionwithoutpigmentadecisionalgorithmfornonpigmentedskinmalignancy AT philipptschandl predictionwithoutpigmentadecisionalgorithmfornonpigmentedskinmalignancy AT agatabulinska predictionwithoutpigmentadecisionalgorithmfornonpigmentedskinmalignancy AT haraldkittler predictionwithoutpigmentadecisionalgorithmfornonpigmentedskinmalignancy AT iriszalaudek predictionwithoutpigmentadecisionalgorithmfornonpigmentedskinmalignancy
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Prediction without Pigment: a decision algorithm for non-pigmented skin malignancy

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