Comparative Analysis of Dermoscopy and Histopathology in the Diagnosis of Melanocytic Lesions in Bangladesh

Abstract

Background: Skin cancer, particularly melanoma, is a growing global health concern, with its incidence steadily rising over the past few decades. In Bangladesh, like many other parts of the world, melanoma poses a significant public health challenge due to its potentially aggressive nature and associated morbidity and mortality. Early diagnosis is paramount in managing melanocytic lesions, as delayed detection can result in a more advanced stage at presentation, making treatment less effective. Traditionally, melanocytic lesions have been diagnosed through histopathology, which requires removing tissue samples and microscopic examination. However, in recent years, dermoscopy has emerged as a non-invasive, highly effective diagnostic tool that complements histopathology in evaluating skin lesions. Aim of the Study: This study aims to assess the sensitivity and specificity of clinical examination and dermoscopic assessment in diagnosing melanocytic lesions compared to histopathological results. Methods: This prospective study was conducted at the Department of Dermatology in Department of Dermatology, Holy Family Red Crescent Medical College Hospital, Dhaka, Bangladesh. 90 patients were recruited for skin cancer screening. The study duration was one year from June2022 to July 2023. The study's sample comprised all melanocytic lesions exhibiting clinical or dermoscopic atypia and lesions of patients who opted for excision for aesthetic or functional reasons. Demographic and clinical data for each patient, including age, gender, lesion location, diameter, border characteristics, symmetry, colours, phototype, and personal or family history of malignant melanoma, were taken. Result: The study involved individuals categorized by age groups, with 14.44% below 20 years, 61.11% between 20 and 39, and 24.44% aged 40 and above. Gender distribution was 46.67% male and 53.33% female. Diagnoses in the study included Benign Common Nevi (53.33%), Dysplastic Nevi (34.44%), and Cutaneous Melanomas (12.22%). The study compared the accuracy of naked eye examination and dermoscopy for identifying atypical cases based on histopathological results. The naked eye examination had a sensitivity of 77.78% and specificity of 71.11%, while dermoscopy had a higher sensitivity of 88.89% and specificity of 93.33%. Dermoscopy also showed a higher positive predictive value (PPV) at 92.22% and a negative predictive value (NPV) at 91.11%. Conclusion: The comparative analysis of dermoscopy and histopathology has highlighted the complementary nature of these diagnostic tools in evaluating melanocytic lesions. Their combined use enhances accuracy and aids in early detection. This collaborative approach promises improved patient outcomes and more precise clinical management of melanocytic lesions.