A risk‐scoring model for the differential diagnosis of lentigo maligna and other atypical pigmented facial lesions of the face: The facial iDScore

Author:

Tognetti Linda1ORCID,Cartocci Alessandra12ORCID,Żychowska Magdalena3ORCID,Savarese Imma4,Cinotti Elisa1,Pizzichetta Maria Antonietta56ORCID,Moscarella Elvira7ORCID,Longo Caterina89,Farnetani Francesca9ORCID,Guida Stefania1011ORCID,Paoli John1213ORCID,Lallas Aimilios14ORCID,Tiodorovic Danica15,Stanganelli Ignazio1617,Magi Serena16,Dika Emi1819ORCID,Zalaudek Iris5,Suppa Mariano202122ORCID,Argenziano Giuseppe7ORCID,Pellacani Giovanni23ORCID,Perrot Jean Luc24,Miracapillo Chiara1,Rubegni Giovanni25,Cevenini Gabriele26,Rubegni Pietro1

Affiliation:

1. Dermatology Unit, Department of Medical, Surgical and Neurosciences University of Siena Siena Italy

2. Department of Medical Biotechnologies University of Siena Siena Italy

3. Department of Dermatology, Institute of Medical Sciences Medical College of Rzeszow University Rzeszów Poland

4. Soc Dermatologia Pistoia‐Prato, USL Toscana Centro Pistoia Italy

5. Dermatology Clinic Ospedale di Trieste Trieste Italy

6. Department of Medical Oncology Centro di Riferimento Oncologico di Aviano (CRO), IRCCS Aviano Italy

7. Dermatology Unit University of Campania Luigi Vanvitelli Naples Italy

8. Centro Oncologico ad Alta Tecnologia Diagnostica, Azienda Unità Sanitaria Locale IRCCS di Reggio Emilia Reggio Emilia Italy

9. Department of Dermatology University of Modena and Reggio Emilia Modena Italy

10. Vita‐Salute San Raffaele University Milan Italy

11. Dermatology Clinic IRCCS San Raffaele Scientific Institute Milan Italy

12. Department of Dermatology and Venereology, Institute of Clinical Sciences, Sahlgrenska Academy, Sahlgrenska University Hospital University of Gothenburg Gothenburg Sweden

13. Department of Dermatology and Venereology Region Västra Götaland, Sahlgrenska University Hospital Gothenburg Sweden

14. First Department of Dermatology Aristotle University Thessaloniki Greece

15. Dermatology Clinic, Medical Faculty University of Nis Niš Serbia

16. Skin Cancer Unit Scientific Institute of Romagna for the Study of Cancer, IRCCS, IRST Meldola Italy

17. Department of Dermatology University of Parma Parma Italy

18. Dermatology Unit, Department of Experimental, Diagnostic and Specialty Medicine (DIMES) University of Bologna Bologna Italy

19. Dermatology IRCCS Azienda Ospedaliero Universitaria di Bologna Bologna Italy

20. Department of Dermatology, Hôpital Erasme Université Libre de Bruxelles Brussels Belgium

21. Groupe d'Imagerie Cutanée Non‐Invasive, Société Française de Dermatologie Paris France

22. Department of Dermatology Institut Jules Bordet Brussels Belgium

23. Department of Dermatology, Policlinico Umberto I University of Rome La Sapienza Rome Italy

24. Dermatology Unit University Hospital of St‐Etienne Saint Etienne France

25. Department of Ophthalmology University of Catania Catania Italy

26. Bioengineering and Biomedical Data Science Lab, Department of Medical Biotechnologies University of Siena Siena Italy

Abstract

AbstractBackgroundDue to progressive ageing of the population, the incidence of facial lentigo maligna (LM) of the face is increasing. Many benign simulators of LM and LMM, known as atypical pigmented facial lesions (aPFLs—pigmented actinic keratosis, solar lentigo, seborrheic keratosis, seborrheic‐lichenoid keratosis, atypical nevus) may be found on photodamaged skin. This generates many diagnostic issues and increases the number of biopsies, with a subsequent impact on aesthetic outcome and health insurance costs.ObjectivesOur aim was to develop a risk‐scoring classifier‐based algorithm to estimate the probability of an aPFL being malignant. A second aim was to compare its diagnostic accuracy with that of dermoscopists so as to define the advantages of using the model in patient management.Materials and MethodsA total of 154 dermatologists analysed 1111 aPFLs and their management in a teledermatology setting: They performed pattern analysis, gave an intuitive clinical diagnosis and proposed lesion management options (follow‐up/reflectance confocal microscopy/biopsy). Each case was composed of a dermoscopic and/or clinical picture plus metadata (histology, age, sex, location, diameter). The risk‐scoring classifier was developed and tested on this dataset and then validated on 86 additional aPFLs.ResultsThe facial Integrated Dermoscopic Score (iDScore) model consisted of seven dermoscopic variables and three objective parameters (diameter ≥ 8 mm, age ≥ 70 years, male sex); the score ranged from 0 to 16. In the testing set, the facial iDScore‐aided diagnosis was more accurate (AUC = 0.79 [IC 95% 0.757–0.843]) than the intuitive diagnosis proposed by dermatologists (average of 43.5%). In the management study, the score model reduced the number of benign lesions sent for biopsies by 41.5% and increased the number of LM/LMM cases sent for reflectance confocal microscopy or biopsy instead of follow‐up by 66%.ConclusionsThe facial iDScore can be proposed as a feasible tool for managing patients with aPFLs.

Publisher

Wiley

Subject

Infectious Diseases,Dermatology

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