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Melanoma-associated leukoderma may be misdiagnosed as vitiligo
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Experts frequently misdiagnosed melanoma-associated leukoderma as vitiligo in a blinded assessment, according to study results recently published in the Journal of the American Academy of Dermatology.
Researchers conducted a study using clinical photographs of 11 patients with melanoma-associated leukoderma (MAL) and 33 patients with vitiligo at The Netherlands Institute for Pigment Disorders in Amsterdam. Four experts in the field conducted the blinded comparison of the photographs, followed by medical history of the patients.
There was a 72.7% misdiagnosis rate of the patients with MAL, with the experts diagnosing 80% of those cases as typical vitiligo. There was a higher median age of onset of leukoderma in the patients with MAL (55 years; P = .001).
The mean positive predictive value for diagnosing MAL was 56.4% and the mean negative predictive value was 79.5%. Three of the four assessors had higher certainty of correctly diagnosed vitiligo compared with correctly diagnosed MAL (P < .05).
The observers did not identify significant differences in clinical presentation of MAL and vitiligo.
“The results of this study illustrate that even experts in the field cannot clearly differentiate between MAL and vitiligo,” the researchers wrote. “Most patients with MAL were given a misdiagnosis based on the assessment of the photographs only.”
“Clinical discrimination between MAL and vitiligo is difficult, which results from lack of specific clinical features,” the researchers concluded. “We propose ‘melanoma-associated vitiligo’ as the more appropriate term for leukoderma in patients with melanoma. Clinicians should be aware that depigmentation in vitiligo can also be caused by melanoma-associated vitiligo and a total body inspection should be performed.” – by Bruce Thiel
Disclosure: The researchers report no relevant financial disclosures.
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