Assessment of prospects of preoperative noninvasive diagnosis of dysplastic nevi

Abstract

Background: dysplastic melanocytic lesions are associated with an increased risk of melanoma while their timely identification remains challenging due to the limited accuracy of currently available visual pre-surgical techniques. Aim: to compare performance and efficacy of two non-invasive skin imaging methods (i. e., epiluminescence dermoscopy (ED) and autofluorescence spectroscopy (AFS])) for the early detection of dysplastic nevi. Materials and Methods: the study included 122 patients with a total of 139 melanocytic lesions. All the lesions were examined by ED using a Heine Delta 20 dermatoscope, and Total Dermoscopy Score (TDS) was calculated by the modified ABCD rule. The same lesions were also assessed by AFS using a laser spectrum analyzer at 450–950 nm. Autofluorescence level and intensity, fluorescence contrast ratio, fluorescence peak shift, and additional spectral peaks were evaluated. All lesions were subsequently excised and subjected to a pathomorphological examination. Diagnostic performance was assessed by sensitivity, specificity, accuracy, positive predictive value (PPV), negative predictive value (NPV), and ROC analysis with AUC calculation. Results: the histopathological examination revealed no dysplasia (n=47), mild or moderate dysplasia (n=42), and severe dysplasia (n=50). To detect melanocytic dysplasia, regardless of grade, AFS demonstrated good sensitivity (100%), specificity (93.6%), accuracy (97.8%), PPV (96.8%), and NPV (100%). As for ED, sensitivity, specificity, accuracy, PPV and NPV were 69.6%, 53.2%, 64.0%, 74.4% and 47.2%, respectively. According to the ROC analysis, AUC were 0.94 and 0.64 for AFS and ED, respectively. To diagnose severe dysplasia, AFS also showed better AUC (0.76) than ED (0.68). Additional fluorescence peaks were reported only in patients with verified dysplasia, and they were more common in those with severe dysplasia. Conclusion: AFS demonstrated higher diagnostic performance than ED in the non-invasive assessment of melanocytic lesions (especially, to detect melanocytic dysplasia of any grade). The method may be considered as a valuable component of a comprehensive early diagnosis of dysplastic nevi. KEYWORDS: melanocytic dysplasia, atypical melanocytic skin neoplasms, autofluorescence diagnostics, epiluminescence dermoscopy. FOR CITATION: Krokhmaleva E.A., Perlamutrov Yu.N., Klyuchnikova D.E., Akopyan A.A. Assessment of prospects of preoperative noninvasive diagnosis of dysplastic nevi. Russian Medical Inquiry. 2026;10(6):338–343 (in Russ.). DOI: 10.32364/2587-6821-2026-10-6-1