{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,5,14]],"date-time":"2025-05-14T04:13:54Z","timestamp":1747196034748,"version":"3.40.5"},"reference-count":36,"publisher":"Public Library of Science (PLoS)","issue":"6","license":[{"start":{"date-parts":[[2021,6,8]],"date-time":"2021-06-08T00:00:00Z","timestamp":1623110400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:p>Early diagnosis when melanoma is still small and thin is essential for improving mortality and morbidity. However, the diagnosis of small size melanoma might be particularly difficult, not only clinically but also dermoscopically. This study aimed to define clinical and dermatoscopic parameters in the diagnosis of suspicious pigmented cutaneous lesions with a diameter of \u2264 6mm and determine the sensitivity, specificity, positive and negative predictive values as well as the accuracy of each clinical and dermatoscopic criterion. This is a transversal, descriptive and analytical study of dermatoscopic analysis with the gold standard being the pathologic examination obtained from the excisional biopsy of suspicious melanocytic lesions with a diameter of \u2264 6mm. Trunk and limb lesion data from a public health service and a private clinic were prospectively collected from 2011 to 2017 by a unique observer. In total, 481 melanocytic lesions were included, with 73.8% being \u2264 4mm in diameter. Overall, 123 were diagnosed as melanoma, 56.0% in situ and 22.0% as thin melanomas (Breslow index 0.1 to 1.0mm). Melanoma presented symmetry in 53.7% of cases, regular borders in 54.5% and a single color in 60.2%. Regarding evolution, 13.8% of melanomas versus 10.9% of benign lesions (p = 0.116) were new by comparing photos from baseline with photos from the follow-up. The majority of melanomas (65%) were found on the limbs compared to 37.2% of the benign lesions at this location (p&lt;0.001). A multiple logistic regression model adjusted for age, gender and location was created. The independent variables associated with the diagnosis of melanoma \u2264 6mm, adjusted for age, gender and location, were: streaks (adjusted Odds Ratio [aOR] 2.5; 95% CI 1.3\u20134.7; p = 0.006), and the presence of a structureless area (aOR 2.2, 95% CI 1.2\u20134.0, p = 0.011). Conversely, a symmetric typical pigment network was a protection variable (aOR 0.4, 95% 0.7\u20130.9, p = 0.040). In conclusion, dermatoscopic criteria have been identified which help to diagnose cases of small size melanoma. These include streaks and structureless areas that can be taken, particularly in consideration for the diagnosis of this subset of small difficult melanomas.<\/jats:p>","DOI":"10.1371\/journal.pone.0252162","type":"journal-article","created":{"date-parts":[[2021,6,8]],"date-time":"2021-06-08T18:30:00Z","timestamp":1623177000000},"page":"e0252162","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":4,"title":["Melanocytic lesions \u2264 6mm: Prospective series of 481 melanocytic trunk and limb lesions in Brazil"],"prefix":"10.1371","volume":"16","author":[{"given":"Gabriella","family":"Campos-do-Carmo","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Aretha Brito","family":"Nobre","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tullia","family":"Cuzzi","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Giuseppe","family":"Argenziano","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Carlos Gil","family":"Ferreira","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2550-6537","authenticated-orcid":true,"given":"Luiz Claudio Santos","family":"Thuler","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"340","published-online":{"date-parts":[[2021,6,8]]},"reference":[{"volume-title":"Cancer facts & figures 2018.","year":"2018","author":"American Cancer Society","key":"pone.0252162.ref001"},{"key":"pone.0252162.ref002","doi-asserted-by":"crossref","first-page":"e014096","DOI":"10.1136\/bmjopen-2016-014096","article-title":"Diagnosing malignant melanoma in ambulatory care: a systematic review of clinical prediction rules","volume":"7","author":"E Harrington","year":"2017","journal-title":"BMJ Open"},{"key":"pone.0252162.ref003","first-page":"282","article-title":"The dermoscopic (7FFM) versus the clinical (ABCDE) diagnosis of small diameter melanoma.","volume":"10","author":"C Benellii","year":"2000","journal-title":"Eur J Dermatol"},{"key":"pone.0252162.ref004","doi-asserted-by":"crossref","first-page":"992","DOI":"10.1002\/1097-0142(20010301)91:5<992::AID-CNCR1089>3.0.CO;2-I","article-title":"Dermoscopic criteria for melanoma in situ are similar to those for early invasive melanoma","volume":"91","author":"MA Pizzichetta","year":"2001","journal-title":"Cancer"},{"key":"pone.0252162.ref005","doi-asserted-by":"crossref","first-page":"319","DOI":"10.1016\/S0733-8635(05)70269-2","article-title":"Difficult early melanomas.","volume":"19","author":"JM Grichnik","year":"2001","journal-title":"Dermatol Clin"},{"key":"pone.0252162.ref006","doi-asserted-by":"crossref","first-page":"1094","DOI":"10.1002\/cncr.10768","article-title":"Dermoscopic and histopathologic diagnosis of equivocal melanocytic skin lesions: an interdisciplinary study on 107 cases","volume":"95","author":"G Ferrara","year":"2002","journal-title":"Cancer"},{"key":"pone.0252162.ref007","doi-asserted-by":"crossref","first-page":"469","DOI":"10.1001\/archderm.144.4.469","article-title":"Utility of lesion diameter in the clinical diagnosis of cutaneous melanoma","volume":"144","author":"NR Abbasi","year":"2008","journal-title":"Arch Dermatol"},{"key":"pone.0252162.ref008","doi-asserted-by":"crossref","first-page":"128","DOI":"10.1177\/030089160409000125","article-title":"Micro-melanoma detection. 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