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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