


7Point 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) 

7Point 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. Milialike cysts
19. Comedolike openings
20. Telangiectasia
21. Redblue areas
22. Maple leaflike areas



Criteria for
nonmelanocytic
lesions

6. Irregular Pigmentation
7. Atypical Vascular Pattern




7Point Scored Diagnosis 
 Odds ratios of each of the 7 criteria were calculated by multivariate analysis.
 7point 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 nonmelanoma.


7Point Checklist:
Definition and Histopathologic Correlates of the 7 MelanomaSpecific 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. Bluewhitish veil 
Irregular, confluent, grayblue to whitishblue diffuse pigmentation 
Acanthotic epidermis with focal hypergranulosis above sheets of heavily pigmented melanocytes in the dermis 
3. Atypical vascular pattern 
Linearirregular 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, dermoepidermal junction, or papillary dermis 
7. Regression structures 
White areas (white scarlike areas) and blue areas (grayblue areas, peppering, multiple bluegray dots) may be associated, thus featuring socalled bluewhitish areas virtually indistinguishable from bluewhitish veil 
Thickned papillary dermis with fibrosis and/or variable amounts of melanophages 


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

ELM criterion 
Odds ratio^{a}

7point score^{b}

Major criteria: 1. Atypical pigment network 
5.19

2

2. Bluewhitish 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 

