Dermatoscopia: uma técnica aplicável para a diferenciação entre lentigo maligno e lentigo maligno melanoma? Uma revisão sistemática da literatura

Abstract

Introduction: The lentigo maligna melanoma (LMM) is a melanoma that arises from the evolution of lentigo maligna (LM). Both lesions have different treatments, so the distinction between them is fundamental for therapeutic planning. Objective: To evaluate whether dermoscopy is an effective diagnostic method for differentiating between LM and LMM. Material and methods: A systematic review of the literature of studies with A or B recommendation grade was performed according to the Center for Evidence-based Medicine's "Levels of Evidence 1", which compared the dermoscopy and histopathology of LM and LMM of skin. We used the following descriptors: dermoscopy, lentigo maligna, lentigo maligna melanoma. The selection of the studies was done using the QUADAS tool (Quality Assessment of Diagnostic Accuracy Studies) -2, recommended for systematic reviews of diagnostic accuracy. Results: Between 1996 and 2018, 224 articles were found, of which 14 were included for qualitative analysis and 5 for meta-analysis. The Heterogeneity test (I-square) for the sensitivity was 97.3% and for the specificity of 92.8%. The pooled sensitivity was 0.74 (Confidence Interval - 95% CI: 0.69-0.78) and the pooled specificity was 0.78 (95% CI: 0.74-0.82). The I-square for positive likelihood ratio was 83.7%, for negative RV was 96.1% and for I-square for diagnostic Odds Ratio (DOR) was 90.4%. Grouped positive RV was 3.68 (95% CI: 2.21-6.13), group negative RV was 0.21 (95% CI: 0.07-0.60) and for group DOR was 28.20 (95% CI: 4.74-179.23). The area under the curve (AUC) was 0.9082. Rhomboid structures were the most frequent dermoscopy criterion associated with LM / LMM. Conclusion: Although dermoscopy has good accuracy in the diagnosis of lentiginous lesions, further studies are needed to determine whether dermoscopy is able to differentiate LM from LMM.