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    7-Point Checklist

    7-Point Checklist

    This simple 10-minute course into melanoma diagnosis using the 7-point checklist will give you an overview of pattern analysis. The 7-point checklist provides a simplification of standard pattern analysis because of the low number of features, or criteria, to identify. As with the ABCD rule, it can be easily learned and applied and has proven to be reliable in diagnosing melanoma. 

     

    Scoring Method for Diagnosis

    Major ELM CriteriaScore
    Atypical pigment network 2
    Gray-blue areas 2
    Atypical vascular pattern 2
    Minor ELM CriteriaScore
    Radial streaming (streaks) 1
    Irregular diffuse pigmentation (blotches) 1
    Irregular dots and globules 1
    Regression pattern 1

    The score for criterion presence is determined on the basis of the odds ratio.

    Odds ratios measure the capacity of each criterion of increasing the probability of a positive melanoma diagnosis.

    By simple addition of the criteria scores, a minimum total score of 3 is required for the diagnosis of melanoma.

     

    Major Criteria - Atypical Pigment Network


     

    Definition
    Prominent (hyperpigmented or broad) and irregular network

    Histological Correlates
    Hyperpigmented or broadened rete ridges with irregular shape or distribution

    Sample Lesion
    Irregular and prominent (atypical) pigment network (white arrow)
    (7-point score: 2)

    streaks (black arrowhead) 
    (score: 1)

    blotches (white arrowhead) 
    (score: 1)

    irregular dots and globules (black arrow) 
    (score: 1)

    Cutaneous melanoma, 0.45 mm thick
    (original magnification 10x)
    TOTAL SCORE: 5

     

    Major Criteria - Atypical Pigment Network


    Definition
    Prominent (hyperpigmented or broad) and irregular network

    Histological Correlates
    Hyperpigmented or broadened rete ridges with irregular shape or distribution

    Sample Lesion
    Irregular, but discrete, pigment network (score: 0)

    Regression pattern (peppering within depigmented areas, asterisk)

    The lesion is asymmetrical , with 4 colors and 3 dermoscopic structures

    irregular dots and globules (black arrow)
    (score: 1)

    Atypical Nevus
    (original magnification 10x)
    TOTAL SCORE: 1

     

    Major Criteria - Gray-Blue Areas


    Definition
    Irregular, confluent, gray-blue to whitish blue diffuse pigmentation not associated with red-blue lacunes or maple leaf pigmentation

    Histological Correlates
    Pigmented melanophages or melanocytes of midreticular dermis location

    Sample Lesion
    with a prevalence of gray-blue areas (curved black arrow) (score: 2)

    An atypical pigment network (white arrow

    streaks (black arrowhead)

    blotches (white arrowhead)
    irregular dots and globules (black arrow)

     

    Cutaneous melanoma, 1.0 mm thick

    (original magnification 10x)
    TOTAL SCORE: 7

     

    Major Criteria - Atypical Vascular Pattern


    Definition
    Linear, dotted, or globular red structures irregularly distributed outside areas of regression and associated with other melanocytic pigment patterns

    Histological Correlates
    Neovascularization or vascularized nests of amelanotic cells

    Sample Lesion
    Atypical (dotted and globular) vascular pattern (long black arrowheads) (score: 2)

    Gray-blue areas (curved black arrow)

    treaks (short black arrowhead)

    Cutaneous melanoma, 0.8 mm thick
    (original magnification 10x)
    TOTAL SCORE: 5

     

    Major Criteria - Atypical Vascular Pattern


    Definition
    Linear, dotted, or globular red structures irregularly distributed outside areas of regression and associated with other melanocytic pigment patterns

    Histological Correlates
    Neovascularization or vascularized nests of amelanotic cells

    Sample Lesion

    Commalike vessels, commonly associated with dermal papillae in compound and dermal nevi(black arrowhead) (score: 0)

    Compound melanocytic nevus
    (original magnification 10x)
    TOTAL SCORE: 5

     

    Minor Criteria - Radial Streaming (Streaks)


    Definition
    Radially and asymmetrically arranged linear or bulbous extensions at the edge of the lesion

    Histological Correlates
    Confluent radial junctional nests of melanocytes

    Sample Lesion
    Streaks (black arrowhead)

    Irregular dots and globules (thin black arrow)

    Regression pattern consists of white areas (asterisk) and peppering (thick black arrow) (score: 1)

    Cutaneous melanoma, 0.6 mm thick
    (original magnification 10x)
    TOTAL SCORE: 3

     

    Minor Criteria - Irregular Diffuse Pigmentation (Blotches)


    Definition
    Brown, gray, and black areas of diffuse pigmentation with irregular shape or distribution and abrupt end

    Histological Correlates
    Hyperpigmentation throughout all levels of the epidermis or upper dermis (in melanocytes or melanophages)

    Sample Lesion
    Blotches (white arrowhead)

    Presence of atypical pigment network (white arrow)

    Relatively symmetrical lesion with abrupt cutoff of pigment pattern, 3 colors, and 4 structures

    streaks (black arrowhead)

    Cutaneous melanoma, 0.3 mm thick
    (original magnification 10x)
    TOTAL SCORE: 4

    Minor Criteria - Irregular Dots And Globules


    Definition
    Black, brown, or blue round structures irregularly distributed within the lesion

    Histological Correlates
    Aggregates of pigment of stratum corneum, junctional, or dermis location

    Sample Lesion
    Irregular dots and globules (black arrows)

    Blotches (white arrowhead)

    Streaks (black arrowhead

    Regression pattern (white areas, thick black arrows)

    Two lesions with similar silhouettes and distribution of colors and structures (see next page)

    Compound melanocytic nevus
    (original magnification 10x)
    TOTAL SCORE: 2

     

    Minor Criteria - Irregular Dots And Globules


    Definition
    Black, brown, or blue round structures irregularly distributed within the lesion

    Histological Correlates
    Aggregates of pigment of stratum corneum, junctional, or dermis location

    Sample Lesion
    Irregular dots and globules (black arrows)

    Blotches (white arrowhead)

    Streaks (black arrowhead

    Regression pattern (white areas, thick black arrows)

    Two lesions with similar silhouettes and distribution of colors and structures (see previous page)

    Cutaneous melanoma, 0.45 mm thick
    (original magnification 10x)
    TOTAL SCORE: 2

     

    Minor Criteria - Regression Pattern


    Definition
    White scarlike depigmentation or "peppering" (speckled multiple blue-gray dots within a hypodepigmented area)irregularly distributed within the lesion

    Histological Correlates
    Areas of loss of pigmentation and fibroplasia, with scattered dermal melanophages

    Sample Lesion
    Regression pattern (black arrows)

    Irregular, discrete pigment network

    The lesion is asymmetrical, with abrupt cutoff of pigment pattern, 4 colors, and 3 dermoscopic structures

    Atypical melanocytic nevus
    (original magnification 10x)
    TOTAL SCORE: 1

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