Dermoscopic Findings in Intraepidermal Carcinoma: An Interobserver Agreement Study

Julia Fougelberg; Alfred Luong; Jonathan Bowling; Alex Chamberlain; Aimilios Lallas; Ashfaq Marghoob; Sam Polesie; Gabriel Salerni; Masaru Tanaka; Oscar  Zaar; Iris Zalaudek; Magdalena Claeson; John Paoli

doi:10.5826/dpc.1301a114

Dermoscopic Findings in Intraepidermal Carcinoma: An Interobserver Agreement Study

Authors

Julia Fougelberg Department of Dermatology and Venereology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden, Region Västra Götaland, Sahlgrenska University Hospital, Department of Dermatology and Venereology, Gothenburg, Sweden
Alfred Luong Department of Dermatology and Venereology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
Jonathan Bowling Private Dermatology Practice, Oxford, UK
Alex Chamberlain Central Clinical School, Monash University, Prahran, VIC, Australia, Victorian Melanoma Service, Alfred Health, Prahran, VIC, Australia
Aimilios Lallas First Department of Dermatology and Venereology, School of Medicine, Faculty of Health Sciences, Aristotle University, Thessaloniki, Greece
Ashfaq Marghoob Memorial Sloan Kettering Cancer Center
Sam Polesie Department of Dermatology and Venereology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden, Region Västra Götaland, Sahlgrenska University Hospital, Department of Dermatology and Venereology, Gothenburg, Sweden
Gabriel Salerni Dermatology Department, Hospital Provincial del Centenario de Rosario, Universidad Nacional de Rosario, Argentina
Masaru Tanaka Tokyo Women’s Medical University Adachi Medical Center
Oscar Zaar Department of Dermatology and Venereology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden, Region Västra Götaland, Sahlgrenska University Hospital, Department of Dermatology and Venereology, Gothenburg, Sweden
Iris Zalaudek Department of Dermatology and Venerology, University of Trieste, Italy
Magdalena Claeson Department of Dermatology and Venereology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden, Region Västra Götaland, Sahlgrenska University Hospital, Department of Dermatology and Venereology, Gothenburg, Sweden
John Paoli Department of Dermatology and Venereology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden, Region Västra Götaland, Sahlgrenska University Hospital, Department of Dermatology and Venereology, Gothenburg, Sweden

Keywords:

Intraepidermal carcinoma, squamous cell carcinoma in situ, Bowen’s disease, dermoscopy, interobserver agreement

Abstract

Introduction: A wide range of descriptive terms have been used for dermoscopic findings in intraepidermal carcinoma (IEC) and the clinical diagnostic accuracy of IEC can be challenging. Furthermore, dermoscopic findings in IEC have only rarely been evaluated in fair-skinned populations.

Objectives: To measure the interobserver agreement between dermatologists for dermoscopic findings in IEC. Furthermore, to describe the frequency of these findings in a predominantly fair-skinned population.

Methods: One hundred dermoscopic images of histopathologically verified IECs were collected. The 11 most common dermoscopic findings described in previous studies were re-defined in a new terminology in a pre-study consensus meeting. Images were assessed by eight experienced international dermoscopists. The frequency of findings and the interobserver agreement was analyzed.

Results: Scales (83%), dotted/glomerular vessels (77%), pinkish-white areas (73%) and hemorrhage (46%) were the most commonly present dermoscopic findings. Pigmented structures were found in 32% and shiny white structures (follicular or stromal) in 54% of the IEC. Vascular structures (vessels and/or hemorrhage) could be seen in 89% of the lesions. Overall, the interobserver agreement for the respective dermoscopic findings was poor to moderate, with the highest kappa values noted for scales (0.55) and hemorrhage (0.54) and the lowest for pinkish-white areas (0.015).

Conclusion: Our results confirm those of previous studies on dermoscopy in IEC, including the frequency of pigmented structures despite the fair-skinned population. The interobserver agreement was relatively low. The proposed new terminology and our findings can hopefully serve as a guideline for researchers, teachers and students on how to identify IEC.

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