{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,17]],"date-time":"2026-10-17T04:42:45Z","timestamp":1792212165236,"version":"4.4.0"},"reference-count":18,"publisher":"Wiley","license":[{"start":{"date-parts":[[2026,10,16]],"date-time":"2026-10-16T00:00:00Z","timestamp":1792108800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,10,16]],"date-time":"2026-10-16T00:00:00Z","timestamp":1792108800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Int J Dermatology"],"abstract":"ABSTRACT<\/jats:title>\n \n Background<\/jats:title>\n External ear melanoma remains poorly characterized by non\u2010invasive imaging. We characterized dermoscopic and reflectance confocal microscopy (RCM) features of auricular melanocytic lesions and evaluated whether combining both modalities improves diagnosis.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n This multicenter retrospective study included 77 auricular lesions evaluated at three tertiary centers. Blinded readers assessed predefined dermoscopic and RCM criteria. Firth\u2010penalized logistic regression was used to develop dermoscopy\u2010only, RCM\u2010only, and combined models. Model development and discrimination were internally validated with 2000 bootstrap replications.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n Thirty melanomas, one melanocytic tumor of uncertain malignant potential, one intraepidermal atypical melanocytic proliferation of uncertain significance, and 45 nevi were analyzed. Lentigo maligna\/lentigo maligna melanoma\u2010like imaging features were observed among melanomas of several histopathological subtypes. The combined model included blue\u2010white veil (odds ratio [OR] 10.79, 95% confidence interval [CI]: 1.72\u201367.72), regression structures (OR 30.16, 95% CI: 3.53\u2013257.97), dendritic pagetoid cells (OR 5.12, 95% CI: 1.25\u201321.08), and medusa head\u2010like structures (OR 10.50, 95% CI: 2.11\u201352.18). It outperformed the dermoscopy\u2010only model (apparent area under the curve [AUC] 0.931 vs. 0.852, DeLong\n p<\/jats:italic>\n \u2009=\u20090.047, Holm\u2010adjusted\n p<\/jats:italic>\n \u2009=\u20090.047). Selection\u2010aware optimism\u2010corrected AUCs were 0.899 and 0.831, respectively. Excluding the two lesions of uncertain malignant potential produced comparable results (AUC 0.952 vs. 0.863, Holm\u2010adjusted\n p<\/jats:italic>\n \u2009=\u20090.040).\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n Auricular melanocytic lesions warrant site\u2010specific and sublocation\u2010aware evaluation. Combining dermoscopy with RCM improved diagnostic discrimination over dermoscopy alone in this cohort, although prospective external validation is required.<\/jats:p>\n \n \n \n image<\/jats:alt-text>\n <\/jats:graphic>\n <\/jats:boxed-text>\n <\/jats:p>\n <\/jats:sec>","DOI":"10.1111\/ijd.70734","type":"journal-article","created":{"date-parts":[[2026,10,17]],"date-time":"2026-10-17T04:16:06Z","timestamp":1792210566000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Combining Dermoscopy and Reflectance Confocal Microscopy to Improve External Ear Melanoma Diagnosis: A Multicenter Retrospective Study"],"prefix":"10.1111","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2711-0579","authenticated-orcid":false,"given":"Jakub","family":"\u017b\u00f3\u0142kiewicz","sequence":"first","affiliation":[{"name":"Department of Dermatology, Venereology and Allergology, Faculty of Medicine Medical University of Gda\u0144sk Gda\u0144sk Poland"},{"name":"Department and Clinic of Dermatology, Venereology and Allergology University Clinical Center Gda\u0144sk Poland"},{"name":"Department of Dermatology University of Modena and Reggio Emilia Modena Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3509-4222","authenticated-orcid":false,"given":"Marco","family":"Spadafora","sequence":"additional","affiliation":[{"name":"Department of Dermatology University of Modena and Reggio Emilia Modena Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5126-8873","authenticated-orcid":false,"given":"Claudio","family":"Conforti","sequence":"additional","affiliation":[{"name":"Skin Cancer Center Istituto Dermopatico dell'Immacolata\u2010IRCCS Rome Italy"},{"name":"Department of Life Science, Health, and Health Professions Link University of Rome Rome Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Silvana","family":"Ciardo","sequence":"additional","affiliation":[{"name":"Department of Dermatology University of Modena and Reggio Emilia Modena Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4768-1387","authenticated-orcid":false,"given":"Roman J.","family":"Nowicki","sequence":"additional","affiliation":[{"name":"Department of Dermatology, Venereology and Allergology, Faculty of Medicine Medical University of Gda\u0144sk Gda\u0144sk Poland"},{"name":"Department and Clinic of Dermatology, Venereology and Allergology University Clinical Center Gda\u0144sk Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7222-2951","authenticated-orcid":false,"given":"Giovanni","family":"Pellacani","sequence":"additional","affiliation":[{"name":"Dermatology Clinic, Department of Clinical Internal, Anesthesiological and Cardiovascular Sciences La Sapienza University Rome Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8218-3896","authenticated-orcid":false,"given":"Caterina","family":"Longo","sequence":"additional","affiliation":[{"name":"Department of Dermatology University of Modena and Reggio Emilia Modena Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,10,16]]},"reference":[{"issue":"9","key":"e_1_2_12_2_1","doi-asserted-by":"crossref","first-page":"1718","DOI":"10.1111\/jdv.19221","article-title":"Dermoscopy of Melanoma According to Different Body Sites: Head and Neck, Trunk, Limbs, Nail, Mucosal and Acral","volume":"37","author":"Longo C.","year":"2023","journal-title":"Journal of the European Academy of Dermatology and Venereology"},{"issue":"4","key":"e_1_2_12_3_1","doi-asserted-by":"crossref","DOI":"10.3390\/cancers17040679","article-title":"Dermoscopy of External Ear Melanocytic Lesions: Performance of Selected Dermoscopic Screening Algorithms and Proposal of a New Predictive Model for Malignancy (AuriCheck Dermoscopic Algorithm)","volume":"17","author":"\u017b\u00f3\u0142kiewicz J.","year":"2025","journal-title":"Cancers"},{"issue":"6","key":"e_1_2_12_4_1","doi-asserted-by":"crossref","first-page":"940","DOI":"10.1111\/jdv.14685","article-title":"Integration of Dermoscopy and Reflectance Confocal Microscopy for Distinguishing Melanomas From Nevi of the Breast Area","volume":"32","author":"Mandel V. D.","year":"2018","journal-title":"Journal of the European Academy of Dermatology and Venereology"},{"issue":"8","key":"e_1_2_12_5_1","doi-asserted-by":"crossref","first-page":"1670","DOI":"10.1111\/jdv.17313","article-title":"Flat Scalp Melanoma Dermoscopic and Reflectance Confocal Microscopy Features Correspond to Histopathologic Type and Lesion Location","volume":"35","author":"Garbarino F.","year":"2021","journal-title":"Journal of the European Academy of Dermatology and Venereology"},{"issue":"5","key":"e_1_2_12_6_1","doi-asserted-by":"crossref","first-page":"849","DOI":"10.1111\/jdv.19006","article-title":"Primum Non Nocere: MelTUMP","volume":"37","author":"Posch C.","year":"2023","journal-title":"Journal of the European Academy of Dermatology and Venereology"},{"issue":"5","key":"e_1_2_12_7_1","doi-asserted-by":"crossref","first-page":"859","DOI":"10.1111\/jdv.18665","article-title":"Clinical Management of Melanocytic Tumours of Uncertain Malignant Potential (MelTUMPs), Including Melanocytomas: A Systematic Review and Meta\u2010Analysis","volume":"37","author":"Varey A. H. R.","year":"2023","journal-title":"Journal of the European Academy of Dermatology and Venereology"},{"issue":"4","key":"e_1_2_12_8_1","doi-asserted-by":"crossref","first-page":"785","DOI":"10.1111\/j.1365-2133.2010.10194.x","article-title":"Seven\u2010Point Checklist of Dermoscopy Revisited","volume":"164","author":"Argenziano G.","year":"2011","journal-title":"British Journal of Dermatology"},{"issue":"10","key":"e_1_2_12_9_1","doi-asserted-by":"crossref","first-page":"1600","DOI":"10.1111\/jdv.70406","article-title":"International Dermoscopy Society Consensus Recommendations for the Management of Lentigo Maligna","volume":"40","author":"Forsea A. 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The External Ear","volume":"99","author":"Montagna W.","year":"1969","journal-title":"Archives of Dermatology"},{"key":"e_1_2_12_13_1","article-title":"Clinical and Dermoscopic Triage of Head and Neck Macules: The Role of Reflectance Confocal Microscopy in a Prospective Study of 2006 Lesions","author":"Guida S.","year":"2026","journal-title":"Journal of the American Academy of Dermatology"},{"issue":"10","key":"e_1_2_12_14_1","doi-asserted-by":"crossref","first-page":"1263","DOI":"10.1007\/s10552-006-0063-1","article-title":"Hypothesis: Hair Cover Can Protect Against Invasive Melanoma on the Head and Neck (Australia)","volume":"17","author":"Green A. C.","year":"2006","journal-title":"Cancer Causes & Control"},{"issue":"4","key":"e_1_2_12_15_1","doi-asserted-by":"crossref","DOI":"10.5826\/dpc.1104a124","article-title":"Clinical and Dermoscopic Features of Melanocytic Lesions on the Face Versus the External Ear","volume":"11","author":"Deinlein T.","year":"2021","journal-title":"Dermatology Practical & Conceptual"},{"issue":"2","key":"e_1_2_12_16_1","doi-asserted-by":"crossref","first-page":"208","DOI":"10.1111\/ijd.15754","article-title":"Morphological Features of Benign Pigmented Ear Lesions: A Cross\u2010Sectional Study","volume":"61","author":"Rishpon A.","year":"2022","journal-title":"International Journal of Dermatology"},{"issue":"4","key":"e_1_2_12_17_1","doi-asserted-by":"crossref","first-page":"802","DOI":"10.1111\/bjd.12678","article-title":"Impact of In\u00a0Vivo Reflectance Confocal Microscopy on the Number Needed to Treat Melanoma in Doubtful Lesions","volume":"170","author":"Alarcon I.","year":"2014","journal-title":"British Journal of Dermatology"},{"issue":"2","key":"e_1_2_12_18_1","doi-asserted-by":"crossref","first-page":"365","DOI":"10.1111\/bjd.13373","article-title":"Integration of Reflectance Confocal Microscopy in Sequential Dermoscopy Follow\u2010Up Improves Melanoma Detection Accuracy","volume":"172","author":"Stanganelli I.","year":"2015","journal-title":"British Journal of Dermatology"},{"issue":"10","key":"e_1_2_12_19_1","doi-asserted-by":"crossref","first-page":"2386","DOI":"10.1038\/jid.2012.172","article-title":"In Vivo Confocal Microscopy for Diagnosis of Melanoma and Basal Cell Carcinoma Using a Two\u2010Step Method: Analysis of 710 Consecutive Clinically Equivocal Cases","volume":"132","author":"Guitera P.","year":"2012","journal-title":"Journal of Investigative Dermatology"}],"container-title":["International Journal of Dermatology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/ijd.70734","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1111\/ijd.70734","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/ijd.70734","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,17]],"date-time":"2026-10-17T04:16:08Z","timestamp":1792210568000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/ijd.70734"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,10,16]]},"references-count":18,"alternative-id":["10.1111\/ijd.70734"],"URL":"https:\/\/doi.org\/10.1111\/ijd.70734","archive":["Portico"],"relation":{},"ISSN":["0011-9059","1365-4632"],"issn-type":[{"value":"0011-9059","type":"print"},{"value":"1365-4632","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,10,16]]},"assertion":[{"value":"2026-08-09","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-10-06","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-10-16","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"ijd.70734"}}