The non-invasive differentiation of lentigo maligna (LM) and lentigo maligna melanomas (LMM) localized on the face (excluding the scalp, neck and ears) rest a daily challenge for dermatologists.(1-3) Indeed, there are multiple possible benign simulators, including: pigmented actinic keratosis (PAK), solar lentigo (SL), seborrheic keratosis (SK), atypical nevus (AN) and lichen planus-like keratosis (LPLK).

Dermoscopic algorithms were developed to date to provide a more standardized approach and support dermosopists in the management of these difficult skin lesions of the face.(3) However, the addiction to data of the clinical history of the patient and of specific clinical features of the lesion could possibly increase the diagnostic accuracy of these checklists.(4,5) We here aim to develop and validate an integrated clinico-dermosocpic scoring system based algorithm dedicated to LM/LMM, for the differential diagnosis from these 5 bening simulators.

The list of clinical-personal data to be evaluated for the the iDScore 2021-facial will include:

• Sex

• Age (years)

• Diameter (mm)

• Phototype (I/II/IIII/IV/V/VI)

• Personal history of melanoma

• Family history of melanoma – 1st degree relative

• Pheomelanine

• Blond hair

• Green/light-blue/blue eyes

• Positive history of sunburns in childhood <14years

• Nevi on the right arm ≥ 11

Beside the histological diangosis of AN / EM, some histologic parameters will be also evlauted, such as:

• Ulceration

• Thickness (mm)

• Mythoses (/mm2) regression

• Lymphocytic infiltrate

1. 1. Stante M, Giorgi V, Stanganelli I, Alfaioli B, Carli P. Dermoscopy for early detection of facial lentigo maligna. JEADV 2005; 152(2): 361-364.
      https://onlinelibrary.wiley.com/doi/full/10.1111/j.1365-2133.2004.06328.

   2. Guida S, Farnetani F, De Pace B, et al. Flat-pigmented facial lesions without highly specific melanocytic dermoscopy features: the role of dermoscopic globules and dots in differential diagnosis with corresponding reflectance confocal microscopy substrates. J Eur Acad Dermatol Venereol. 2019 Nov 15. [Epub ahead of print]
      https://www.ncbi.nlm.nih.gov/pubmed/31729773

   3. Micantonio T, Neri L, Longo C, et al. A new dermoscopic algorithm for the differential diagnosis of facial lentigo maligna and pigmented actinic keratosis. Eur J Dermatol. 2018; 28(2):162-168.
      https://www.ncbi.nlm.nih.gov/pubmed/29620004

   4. Tognetti L, Cinotti E, Moscarella E, Farnetani F, Malvehy J, Lallas A, Pellacani G, Argenziano G, Cevenini G, Rubegni P. Impact of clinical and personal data in the dermoscopic differentiation between early melanoma and atypical nevi. Dermatol Pract Concept. 2018 Oct 31;8(4):324-327.
      https://www.ncbi.nlm.nih.gov/pubmed/30479866

   5. Tognetti L, Cevenini G, Moscarella E, Cinotti E, Farnetani F, Mahlvey J, Perrot JL, Longo C, Pellacani G, Argenziano G, Fimiani M, Rubegni P. An integrated clinical-dermoscopic risk scoring system for the differentiation between early melanoma and atypical nevi: the iDScore. J Eur Acad Dermatol Venereol. 2018 Dec; 32(12):2162-2170.
      https://www.ncbi.nlm.nih.gov/pubmed/29888421