Predictive models of melanoma metastasis based on dermatoscopy in an international retrospective human reader study.

Current melanoma prognostic tools have limited clinical use at the bedside, highlighting the need for more effective biomarkers. Dermatoscopy correlates with established prognostic markers obtained through invasive procedures. However, its direct predictive value for metastasis remains unexplored. In this multinational study, 30 dermatologists evaluated 776 dermatoscopic images of melanomas (stage IB and above) for predefined criteria including structures, colors and vessels. Extensive dermatoscopic ulceration and blue-white veil are associated with increased risk of metastasis in the total cohort and reduced recurrence-free survival in early-stage melanomas, while extensive regression is associated with reduced metastasis risk and improved recurrence-free survival. Three predictive models of metastasis: (1) dermatoscopic features only, (2) histopathologic features only, and (3) a combination of both demonstrate comparable prognostic accuracy. Here, we show that dermatoscopy may offer valuable prognostic insights into melanoma's biological behavior before excision and help guide therapeutic decisions. Prospective validation in future trials is essential.