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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
1) Low number of features to identify
2) Scoring diagnostic system
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Consensus Meeting (1990) |
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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
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1. Atypical Pigment Network
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9. Pseudopods
10. Radial streaming
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2. Irregular Streaks
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11. Brown globules
12. Black dots
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3. Irregular Dots/globules
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13. Whitish veil
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4. Blue - whitish veil
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14. White scarlike areas
15. Gray - blue areas
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5. Regression Structures
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16. Hypopigmented areas (not siginificant)
17. Reticular depigmentation (not significant)
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(Additional criteria)
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18. Milia-like cysts
19. Comedo-like openings
20. Telangiectasia
21. Red-blue areas
22. 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 |
- 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.
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7-Point Checklist:
Definition and Histopathologic Correlates of the 7 Melanoma-Specific Dermoscopic Criteria
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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 |
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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 |
Odds ratioa
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7-point scoreb
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Major criteria: 1. Atypical pigment network |
5.19
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2
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2. Blue-whitish veil |
11.1
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2
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3. Atypical vascular pattern |
7.42
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2
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Minor criteria: 4. Irregular streaks |
3.01
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1
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5. Irregular pigmentation |
4.90
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1
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6. Irregular dots/globules |
2.93
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1
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7. Regression structures |
3.89
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1
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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).
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Simply add the scores of each criterion that is present within a pigmented lesion. |
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Melanoma:
7-point score = 7
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Melanoma:
7-point score = 3
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Clark nevus:
7-point score = 1 |
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Melanoma:
7-point score = 6 |
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Melanoma:
7-point score = 5 |
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