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

Miquel Armengot-Carbó, Eduardo Nagore, Zaida García-Casado, Rafael Botella-Estrada

The genetic basis of melanoma affects its clinicopathological characteristics and increasingly influences its management. 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 based on dermoscopic and clinicopathological features easily accessible in normal clinical practice. A prospective, cross-sectional, observational, and descriptive study was performed. Ninety-three cutaneous melanomas with dermoscopic images from 93 patients were included. BRAF mutational status was determined by genetic analysis using two methods: cobas 4800 BRAF V600 Mutation Test and Sanger sequencing. Clinicopathological data were collected; dermoscopic images were analyzed by two independent blind observers. Blue-white veil in dermoscopy was significantly associated with BRAF mutations (OR: 4.3; 95% CI: 1.6-11.5; p=0.003). Patients with BRAF-mutated melanomas were significantly younger than those with wild-type melanomas (OR: 0.96; 95% CI: 0.93-0.99; p=0.008). Based on these two variables, it was possible to predict BRAF mutational status in melanoma with 73% accuracy. Histological data were obtained from pathology reports. The accuracy of the predictive model has not been tested with a new dataset. Blue-white veil in dermoscopy is associated with BRAF mutations in cutaneous melanoma.