Clinical, Dermoscopic, and Histopathological Correlation of Pigmented Skin Lesions at a Tertiary Care Dermatology Center

Background and objectivePigmented skin lesions encompass a wide spectrum of benign and malignant conditions that may present with overlapping clinical features.Dermoscopy enhances visualization of subsurface structures and can improve early detection of cutaneous malignancies when correlated with histopathological findings.However, local evidence on the agreement and diagnostic performance of clinical examination and dermoscopy compared to histopathology remains limited, particularly within tertiary care dermatology settings in Pakistan.This study was conducted to evaluate the clinical, dermoscopic, and histopathological correlation of pigmented skin lesions and to determine the diagnostic accuracy of dermoscopy in detecting cutaneous malignancies. MethodologyThis prospective observational study was carried out at Combined Military Hospital (CMH) Kharian Medical College, Gujrat, Pakistan, from January 2024 to June 2024 and enrolled 75 patients with pigmented skin lesions.All participants underwent a standardized clinical examination, dermoscopic evaluation, and biopsy with histopathological assessment.Patients with previously treated malignancies, non-evaluable lesions, contraindications to biopsy, or incomplete data were excluded. ResultsThe mean age of the patients was 46.8 ± 15.2 years, and 41 (54.7%) were male.Histopathology confirmed 50 (66.7%)benign and 25 (33.3%)malignant lesions.Benign melanocytic nevus was the most common diagnosis, occurring in 25 (33.3%)patients, whereas basal cell carcinoma was the most frequent malignancy in 11 (14.7%),followed by malignant melanoma in eight (10.7%) and squamous cell carcinoma in six (8.0%).Malignant lesions had a significantly larger mean diameter than benign lesions (13.7 ± 4.1 mm vs. 7.8 ± 2.6 mm; p < 0.001).Border irregularity, color variegation, asymmetry, blue-white veil, atypical vascular patterns, and multiple dermoscopic colors were significantly more frequent in malignant lesions.Dermoscopy demonstrated a sensitivity of 92.0%, a specificity of 94.0%, a positive predictive value (PPV) of 88.5%, a negative predictive value (NPV) of 95.9%, and an overall diagnostic accuracy of 93.3%.Agreement with histopathology was stronger for dermoscopy than for clinical examination, with Cohen's kappa values of 0.84 and 0.62, respectively. ConclusionsDermoscopy demonstrated higher diagnostic performance and stronger agreement with histopathology than routine clinical examination.Its use may facilitate more accurate assessment and earlier identification of malignant pigmented skin lesions.