The association between dermoscopic features and BRAF mutational status in cutaneous melanoma: Significance of the blue-white veil

• Published in: Journal of the American Academy of Dermatology Vol. 78; no. 5; pp. 920 - 926.e4
• Main Authors: Armengot-Carbó, Miquel, Nagore, Eduardo, García-Casado, Zaida, Botella-Estrada, Rafael
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01-05-2018
• Subjects: Adult; Aged; blue-white veil; BRAF; Confidence Intervals; Cross-Sectional Studies; dermatology; Dermoscopy; DNA Mutational Analysis; exophytic papillary structures; Female; Gene Expression Regulation, Neoplastic; genetics; Humans; Male; melanoma; Melanoma - diagnosis; Melanoma - genetics; Middle Aged; Odds Ratio; oncology; pathology; Predictive Value of Tests; Prognosis; Prospective Studies; Proto-Oncogene Proteins B-raf - genetics; Risk Assessment; Skin Neoplasms - diagnosis; Skin Neoplasms - genetics; streaks; ulceration; blue-white veil; streaks; exophytic papillary structures; ulceration; dermatology; genetics; pathology; melanoma; BRAF; oncology; dermoscopy
• ISSN: 0190-9622; 1097-6787
• DOI: 10.1016/j.jaad.2017.12.064

The genetic basis of melanoma affects its clinicopathologic characteristics and increasingly influences its management. B-Raf proto-oncogene, serine/threonine kinase gene (BRAF)-mutated melanoma may present with specific dermoscopic features.
To identify the dermoscopic features associated with BRAF mutation in cutaneous melanoma and to evaluate a model capable of predicting BRAF mutations on the basis of dermoscopic and clinicopathologic features that are easily accessible in normal clinical practice.
A prospective, cross-sectional, observational, and descriptive study was performed. A total of 93 cutaneous melanomas with dermoscopic images from 93 patients were included. BRAF mutational status was determined by genetic analysis using 2 methods: cobas 4800 BRAF V600 Mutation Test (Roche Molecular Systems, Pleasanton, CA) and Sanger sequencing. Clinicopathologic data were collected; dermoscopic images were analyzed by 2 independent blind observers.
Blue-white veil in dermoscopy was significantly associated with BRAF mutations (odds ratio, 4.3; 95% confidence interval, 1.6-11.5; P = .003). Patients with BRAF-mutated melanomas were significantly younger than those with wild-type melanomas (odds ratio, 0.96; 95% confidence interval, 0.93-0.99; P = .008). On the basis of these 2 variables, it was possible to predict BRAF mutational status in melanoma with 73% accuracy.
Histologic data were obtained from pathology reports. The accuracy of the predictive model has not been tested with a new data set.
Blue-white veil in dermoscopy is associated with BRAF mutations in cutaneous melanoma.