Clinical-Dermoscopic Risk Score Discriminates Plantar Atypical Melanocytic Lesions
Applying model reduces number of misdiagnosed plantar atypical nevi and number of plantar atypical nevi excised
By Dermsquared Editorial Team | May 28, 2025
WEDNESDAY, May 28, 2025 (HealthDay News) -- A simple scoring tool, the iDScore_plantar model, can help discriminate plantar atypical melanocytic lesions (pAMLs), according to a study published online May 20 in the Journal of the European Academy of Dermatology and Venereology.
Linda Tognetti, M.D., from the University of Siena in Italy, and colleagues developed a clinical-dermoscopic risk-scoring model to help discriminate pAMLs. A total of 490 pAMLs (98 plantar early melanomas [pEM] and 392 plantar atypical nevi [pAN]) were collected and paired with histopathological diagnosis, dermoscopic and clinical image, maximum lesion diameter, plantar location, and age and sex of the patient. The dataset was divided into training, validation, and testing subsets (261, 174, and 55 pAMLs, respectively). A blinded teledermoscopic test was performed by 104 dermatologists and 56 residents; the test included intuitive diagnosis, pattern analysis, rating of case difficulty, diagnostic confidence assessment, and management decision.
Overall, 2,887 dermoscopic evaluations were obtained. The average area under the receiver operating characteristic curve was 0.95 for the iDScore_plantar model compared with 0.77 for pattern analysis. The score was composed of the sum of five scores; decisions regarding long/short follow-up, biopsy, and excision were matched with four risk score ranges: no risk, low-medium risk, medium-high risk, and very high risk. The researchers found that participants would have reduced the number of misdiagnosed pAN and the number of pAN excised by −25.5 and −27.7 percent, respectively, by applying the model, and would have increased the number of correctly diagnosed pEM by +18.5 percent and the number of pEM recommended for surgical excision and recommended directly for surgical excision instead of biopsy by +8.5 and +16.15 percent, respectively.
"This tool may be suitable for use by residents and specialists, as both appear to benefit from it in terms of correct classification and appropriate management," the authors write.