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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

9. Pseudopods
10. Radial streaming

2. Irregular Streaks

11. Brown globules
12. Black dots

3. Irregular Dots/globules

13. Whitish veil

4. Blue - whitish veil

14. White scarlike areas
15. Gray - blue areas

5. Regression Structures

16. Hypopigmented areas (not siginificant)
17. Reticular depigmentation (not significant)


(Additional criteria)

18. Milia-like cysts
19. Comedo-like openings
20. Telangiectasia
21. Red-blue areas
22. Maple leaf-like areas

Criteria for

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


2. Blue-whitish veil
3. Atypical vascular pattern
Minor criteria:
4. Irregular streaks


5. Irregular pigmentation
6. Irregular dots/globules
7. Regression structures

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.
7-point score = 7


7-point score = 3


  Clark nevus: 
7-point score = 1


7-point score = 6


7-point score = 5


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