LAUSR

BACKGROUND Nevus phenotype is a marker of melanoma risk. In-vivo prediction of microscopic pattern is needed to more precisely classify nevi. OBJECTIVE To identify dermoscopic and clinical predictors of microscopic patterns of typical nevi. METHODS We used reflectance confocal microscopy (RCM) to classify microscopic patterns of nevi. We prospectively accrued adults presenting for periodic-skin-screening and imaged, with dermoscopy and RCM, three randomly-selected nevi - from upper and lower back and lower extremity. RCM patterns were classified into Ring, Clod, Meshwork, and Composite. Logistic-regression was used to identify best predictors of RCM pattern. RESULTS The study included 310 nevi from 112 participants (mean age=44; 51 females). Dermoscopic-reticular pattern correlated most frequently (59.9%) with RCM-Ring pattern, dermoscopic-globular with RCM-Composite (56.6%) and RCM-Clod (35.9%), dermoscopic-complex with RCM-Composite (76.3%), and dermoscopic-homogenous with RCM-Clod (50.8%). Integrating dermoscopic pattern with contour, diameter, color and anatomic location of nevi, improved prediction of microscopic patterns beyond dermoscopy alone. The dermoscopic-clinical regression-model correctly classified lesions to RCM-Ring vs. RCM-Clod in 90%, and to RCM-Ring vs. RCM-Composite patterns in 81%. LIMITATIONS The study was restricted to adults, back and lower extremities and typical nevi. CONCLUSIONS Integrating dermoscopic patterns with clinical attributes may improve prediction of microscopic patterns of nevi.