CLINICAL, DERMOSCOPIC AND HISTOPATHOLOGICAL CORRELATION OF PIGMENTED FACIAL LESIONS: A PROSPECTIVE OBSERVATIONAL STUDY

Abstract

Background: Pigmented facial lesions comprise a heterogeneous group of disorders ranging from benign melanocytic and epidermal lesions to premalignant and malignant conditions. Clinical examination alone may not always reliably differentiate these lesions. Dermoscopy provides additional morphological information and may improve diagnostic accuracy, while histopathology remains the definitive diagnostic method. The present study was undertaken to evaluate the clinical, dermoscopic and histopathological features of pigmented facial lesions and determine their correlation.
Materials and Methods: This prospective observational study included 85 patients with pigmented facial lesions. Detailed clinical examination was performed with documentation of age, sex, duration, anatomical site, morphology, colour and clinical diagnosis. Dermoscopic examination was subsequently performed to identify pigment networks, pseudonetworks, dots and globules, structureless areas, blue-grey structures, regression features and vascular patterns. Histopathological examination was performed according to the study protocol, and clinical and dermoscopic findings were correlated with the final histopathological diagnosis. Diagnostic performance of dermoscopy was assessed using sensitivity, specificity, positive predictive value, negative predictive value and overall diagnostic accuracy.
Results: Among the 85 patients, 53 (62.4%) were females and 32 (37.6%) were males. The most frequent age group was 41–50 years (20; 23.5%). The cheek was the commonest anatomical site (27; 31.8%), while macular lesions constituted the predominant morphology (37; 43.5%). Dark-brown pigmentation was the most frequent colour pattern (25; 29.4%). Melasma was the commonest clinical diagnosis (18; 21.2%). On dermoscopy, homogeneous pigmentation (31; 36.5%), structureless brown areas (28; 32.9%) and pseudonetwork (24; 28.2%) were frequently observed. Histopathological examination demonstrated 29 (34.1%) positive/significant lesions, while 56 (65.9%) were benign/negative. Among the positive lesions, pigmented actinic keratosis accounted for 7 (24.1%), pigmented basal cell carcinoma for 6 (20.7%), atypical melanocytic nevus for 5 (17.2%) and melanoma for 4 (13.8%). Dermoscopy correctly identified 25 of the 29 positive lesions. Its sensitivity was 86.2%, specificity 82.1%, positive predictive value 71.4%, negative predictive value 92.0%, and overall diagnostic accuracy 83.5%.
Conclusion: Pigmented facial lesions demonstrate considerable clinical and dermoscopic variability. Dermoscopy provides valuable additional diagnostic information and showed good agreement with histopathological findings in this study. However, histopathological examination remains essential for definitive diagnosis, particularly in lesions showing suspicious clinical or dermoscopic features.