7-Point Checklist: Validated dermoscopic algorithm for pigmented lesion triage.
Major Criteria (2 pts)
Minor Criteria (1 pt)
Awaiting Observation
Select the dermoscopic features identified during the lesion examination to calculate the 7-point checklist score.
Guidelines & Evidence
Verified
Last Review: 2026-07-17
When to Use
When to Use
The Argenziano 7-Point Dermoscopy Checklist is a validated, point-scored algorithm for stratifying the melanoma risk of pigmented skin lesions under dermoscopy (epiluminescence microscopy). It provides a structured, teachable approach to dermoscopic diagnosis suitable for dermatologists and trained general practitioners, and is particularly useful in high-volume pigmented lesion clinics where rapid triage decisions are required.
Primary Indications
Triage of clinically equivocal pigmented melanocytic lesions under dermoscopy
Differentiating melanoma from benign melanocytic nevi, dysplastic nevi, and Spitz nevi
Supporting excision decisions in pigmented lesion clinics when pattern analysis is inconclusive
Training and structured learning for dermatologists new to dermoscopy
When NOT to Use
Non-melanocytic lesions (seborrhoeic keratoses, BCC, haemangiomas) — use specific dermoscopic criteria for each lesion type
Acral lentiginous melanoma on palms/soles — parallel ridge pattern is the key criterion; standard 7-point criteria have lower sensitivity
Amelanotic or hypomelanotic lesions — criteria require pigment; use vascular pattern analysis instead
As a replacement for excision — a score ≥ 3 mandates biopsy; dermoscopy does not substitute histopathology
Without formal dermoscopy training — untrained use of the checklist reduces sensitivity and specificity significantly
Clinical Threshold
A score ≥ 3 is highly suspicious for melanoma and mandates excisional biopsy. Avoid punch or shave biopsy when melanoma is suspected — partial sampling may compromise Breslow depth measurement and staging accuracy.
How it Works
Major Criteria (2 Points Each)
| Atypical pigment network | Irregular meshwork with thickened lines, irregular holes, and abrupt ending at the periphery — corresponds to irregular rete ridges with melanin distribution |
| Blue-white veil | Irregular, confluent blue-white pigmentation with overlying white "ground-glass" haze — correlates with acanthotic epidermis over heavily pigmented melanoma cells and melanophages in the dermis |
| Atypical vascular pattern | Irregular, dotted, linear-irregular, or hairpin vessels not clearly arranged in a regular distribution — reflects tumour neovascularization |
Minor Criteria (1 Point Each)
| Irregular streaks | Radial streaming or pseudopods at the periphery — correlates with radial growth phase of melanoma at the tumour margin |
| Irregular pigmentation (blotches) | Structureless, asymmetrically distributed areas of dark brown, black, or grey pigmentation not centrally located |
| Irregular dots/globules | Varying sizes and shapes, asymmetrically distributed — unlike regular brown globules of Miescher naevi |
| Regression structures | White scar-like depigmented areas and/or blue-grey pepper-like granules (peppering) — corresponds to fibrosis and melanophages from regressing melanoma |
Scoring and Interpretation
| Score < 3 | Low suspicion — monitor with digital dermoscopy; reassess at 3–6 months if any change noted |
| Score ≥ 3 | High suspicion for melanoma — excisional biopsy mandatory |
Diagnostic Performance
In the original Argenziano 1998 validation (n=342 lesions, 96 melanomas), the 7-point checklist achieved sensitivity of 95% and specificity of 75% for melanoma at a threshold of ≥ 3. Sensitivity is prioritised over specificity in this context — the clinical cost of a missed melanoma exceeds the cost of an unnecessary biopsy.
Clinical Pearls
Key Pearls
The 7-point checklist is a simplification of full dermoscopic pattern analysis — it is designed for rapid triage, not for replacing comprehensive analysis in specialist hands.
Blue-white veil (major, 2 points) is the single most specific dermoscopic feature for invasive melanoma; its presence alone should trigger strong consideration of excision.
Regression structures (1 point) in the context of any other criterion should heighten suspicion — regression correlates with melanoma host immune response and may indicate a thicker in-situ or early invasive lesion.
Spitz/Reed nevi can score ≥ 3 due to a "starburst" pattern (irregular streaks + regular blotches) — these are excised in any patient > 12 years because histological distinction from melanoma requires excision.
The 7-point checklist was validated on dermoscopy images at 10× magnification — performance may differ with smartphone-based dermoscopy at lower magnification.
Comparator Algorithms
| ABCD Rule (Stolz) | Asymmetry, Border, Colour, Differential structures. Provides a Dermoscopy Score (TDS); TDS > 5.45 = melanoma. More complex, similar sensitivity. |
| Menzies Method | Requires absence of symmetry + one of 9 positive features. Binary approach; used in Australian primary care settings. |
| Pattern Analysis | Full expert pattern recognition — highest accuracy in experienced hands but not structured for rapid scoring. |
| CASH Algorithm | Colour, Architecture, Symmetry, Homogeneity — simplified 4-criterion approach for novice users. |
Guideline Position
AAD (2021) and EDF/EADO melanoma dermoscopy guidelines endorse the 7-point checklist as a validated Level B evidence algorithm suitable for trained dermoscopists. Digital total-body photography combined with serial dermoscopy monitoring is recommended for high-risk patients (> 50 nevi, personal/family history of melanoma, atypical mole syndrome).
Next Steps
Action by Score
| Score 0–2 (Low suspicion) | Monitor with digital dermoscopy photography. Reassess at 3 months if any subjective change (growth, colour change, new symptom). Routine 6–12 month surveillance if in high-risk patient. |
| Score ≥ 3 (High suspicion) | Excisional biopsy with 1–3 mm clinical margins. Do not perform punch, shave, or curettage biopsy — this may compromise Breslow depth, sentinel node decision, and staging accuracy. |
Post-Biopsy Pathway
01
If histology confirms melanoma in situ: Wide local excision (WLE) 0.5–1 cm margin; no further staging
02
If T1a melanoma (Breslow ≤ 0.8 mm, no ulceration): WLE 1 cm margin; sentinel lymph node biopsy (SLNB) discretionary (< 5% SLN positivity)
03
If T1b (≤ 0.8 mm + ulceration, or 0.8–1.0 mm): WLE 1 cm margin; discuss SLNB (MSLT-I data supports staging benefit)
04
If T2–T4 or node-positive: Refer to melanoma MDT; discuss adjuvant immunotherapy (pembrolizumab, nivolumab) or targeted therapy (BRAF/MEK inhibitors if BRAF V600E positive)
05
Excision margin of initial biopsy: Document in histopathology request — complete excision vs. involved margins guides re-excision planning
Biopsy Technique
Never use punch or shave biopsy if melanoma is suspected. Partial sampling can: (1) underestimate Breslow depth if the thickest part is not sampled; (2) alter lymphatic drainage and invalidate SLNB results; (3) lead to downstaging and under-treatment. Use narrow-margin (1–3 mm) elliptical excision oriented along lymphatic drainage lines.
The Evidence
Original Derivation
Epiluminescence microscopy for the diagnosis of doubtful melanocytic skin lesions. Comparison of the ABCD rule of dermatoscopy and a new 7-point checklist based on pattern analysis.
Argenziano G et al. • Arch Dermatol. 1998;134(12):1563-1570. Derivation and validation on 342 pigmented lesions (96 melanomas); 7-point checklist sensitivity 95%, specificity 75% at threshold ≥ 3.
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Origins & History
Origins
The 7-Point Dermoscopy Checklist was developed by Giuseppe Argenziano and colleagues at the University of Naples Federico II, Italy, and published in Archives of Dermatology in 1998. Argenziano sought to create a structured, teachable alternative to full dermoscopic pattern analysis — which requires years of expert training — that could be reliably applied by general dermatologists in high-volume clinical settings. By assigning differential point weights (major 2 points, minor 1 point) based on the relative odds ratios of each feature for melanoma, the checklist provides a quasi-quantitative triage tool. Argenziano went on to become one of the most prolific dermoscopy researchers globally, co-founding the International Dermoscopy Society (IDS) and contributing to the development of the interactive Atlas of Dermoscopy. The checklist is now embedded in dermoscopy training curricula across Europe, Australia, and North America.
Last Comprehensive Review: 2026-07-17