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Practice Gaps |

Failure to Compare Dermoscopy Findings of Pigmented Lesions on Your Patient:  Comment on “Dermoscopy of Patients With Multiple Nevi”

Douglas Grossman, MD, PhD
Arch Dermatol. 2011;147(1):50. doi:10.1001/archdermatol.2010.390.
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Ideally, clinical tools used to detect melanoma discriminate between benign and malignant lesions allowing prompt excision of melanomas and minimal removal of benign nevi. For many clinicians, dermoscopy is used to view questionable lesions at one point in time, but this has reduced specificity since melanomas and nevi often share overlapping morphologic characteristics.1 Argenziano et al analyzed management of suspicious pigmented lesions in 2 contexts. First, a group of 6 dermatologists made recommendations regarding excision of 190 clinically atypical lesions based only on their examination of individual dermoscopic photographs. Second, the group was asked to reevaluate the same lesions alongside photographs of additional lesions from the same patients. Excision was recommended in 55% of cases in the first approach, but in only 14% of cases in the comparative approach. Although excision was recommended for the melanomas in both approaches, the comparative approach (assuming the remaining lesions were nevi) would be associated with far fewer benign nevi removals. Thus minding this “practice gap” through contextual dermoscopic analysis can limit unnecessary nevus removals that will benefit patients and reduce long-term costs of screening.

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