Clinical and Laboratory Investigations Dermatology 2004;208:27–31 DOI: 10.1159/000075042 Three-Point Checklist of Dermoscopy A New Screening Method for Early Detection of Melanoma H. Peter Soyer a Giuseppe Argenziano b Iris Zalaudek a Rosamaria Corona c Francesco Sera c Renato Talamini e Filomena Barbato b Adone Baroni b Lorenza Cicale b Alessandro Di Stefani d Pietro Farro b Luigi Rossiello b Eleonora Ruocco b Sergio Chimenti d a Department of Dermatology, University of Graz, Graz, Austria; b Department of Dermatology, Second University of Naples, Naples, c Istituto Dermopatico dell’Immacolata and d Department of Dermatology, University Tor Vergata of Rome, Rome, and e National Cancer Institute, Aviano, Italy Received: May 19, 2003 Accepted: July 29, 2003 Giuseppe Argenziano, MD Department of Dermatology Second University of Naples, Via S. Pansini, 5 IT–80131 Naples (Italy) Tel./Fax +39 081 566 6675, E-Mail argenziano@tin.it ABC Fax + 41 61 306 12 34 E-Mail karger@karger.ch www.karger.com © 2004 S. Karger AG, Basel 1018–8665/04/2081–0027$21.00/0 Accessible online at: www.karger.com/drm Key Words Dermoscopy W Melanoma W Pigmented skin lesions Abstract Background: Dermoscopy used by experts has been demonstrated to improve the diagnostic accuracy for melanoma. However, little is known about the diagnostic validity of dermoscopy when used by nonexperts. Objec- tive: To evaluate the diagnostic performance of nonex- perts using a new 3-point checklist based on a simplified dermoscopic pattern analysis. Methods: Clinical and der- moscopic images of 231 clinically equivocal and histo- pathologically proven pigmented skin lesions were ex- amined by 6 nonexperts and 1 expert in dermoscopy. For each lesion the nonexperts assessed 3 dermoscopic cri- teria (asymmetry, atypical network and blue-white struc- tures) constituting the 3-point method. In addition, all examiners made an overall diagnosis by using standard pattern analysis of dermoscopy. Results: Asymmetry, atypical network and blue-white structures were shown to be reproducible dermoscopic criteria, with a kappa value ranging from 0.52 to 0.55. When making the over- all diagnosis, the expert had 89.6% sensitivity for malig- nant lesions (tested on 68 melanomas and 9 pigmented basal cell carcinomas), compared to 69.7% sensitivity achieved by the nonexperts. Remarkably, the sensitivity of the nonexperts using the 3-point checklist reached 96.3%. The specificity of the expert using overall diagno- sis was 94.2% compared to 82.8 and 32.8% achieved by the nonexperts using overall diagnosis and 3-point checklist, respectively. Conclusion: The 3-point checklist is a valid and reproducible dermoscopic algorithm with high sensitivity for the diagnosis of melanoma in the hands of non-experts. Thus it may be applied as a screening procedure for the early detection of mela- noma. Copyright © 2004 S. Karger AG, Basel Introduction Melanoma is a life-threatening disease that can be completely cured if the lesion is removed in its early stages. Therefore, removal of all lesions that clinically and/or dermoscopically might be suggestive of melanoma is warranted, while the excision of benign lesions should be minimized. Two recent systematic reviews [1, 2] revealed that dermoscopy performed by experienced us- ers is more accurate than clinical examination for the diagnosis of melanoma. The fact that dermoscopy needs experience and that it is best used by well-trained derma- tologists has already been emphasized [2, 3].