Accuracy of dermatoscopy for the diagnosis of nonpigmented cancers of the skin - 23/11/17

Doi : 10.1016/j.jaad.2017.07.022

Christoph Sinz, MD ^a, Philipp Tschandl, MD, PhD ^a, Cliff Rosendahl, MBBS, PhD ^b,^c, Bengu Nisa Akay, MD ^d, Giuseppe Argenziano, MD, PhD ^e, Andreas Blum, MD ^f, Ralph P. Braun, MD ^g, Horacio Cabo, MD, PhD ^h, Jean-Yves Gourhant, MD ⁱ, Juergen Kreusch, MD, PhD ^j, Aimilios Lallas, MD ^k, Jan Lapins, MD, PhD ^l, Ashfaq A. Marghoob, MD ^m, Scott W. Menzies, MBBS, PhD ⁿ, John Paoli, MD, PhD ^o, Harold S. Rabinovitz, MD ^p, Christoph Rinner, PhD ^q, Alon Scope, MD ^r, H. Peter Soyer, MD, FACD ^s, Luc Thomas, MD, PhD ^t, Iris Zalaudek, MD ^u, Harald Kittler, MD ^a,^⁎
^a Department of Dermatology, Division of General Dermatology, Medical University of Vienna, Vienna, Austria
^b Faculty of Medicine, The University of Queensland, Brisbane, Australia
^c School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
^d Department of Dermatology, Ankara University Faculty of Medicine, Ankara, Turkey
^e Dermatology Unit, University of Campania, Naples, Italy
^f Public, Private and Teaching Practice of Dermatology, Konstanz, Germany
^g Department of Dermatology, University Hospital Zurich, Zurich, Switzerland
^h Department of Dermatology, Instituto de Investigaciones Médicas “A. Lanari,” University of Buenos Aires, Buenos Aires, Argentina
ⁱ Centre de Dermatologie, Nemours, France
^j Private Dermatology Practice, Lübeck, Germany
^k First Department of Dermatology, Aristotle University, Thessaloniki, Greece
^l Department of Dermatology, Karolinska University Hospital, Stockholm, Sweden
^m Memorial Sloan Kettering Cancer Center, Hauppauge, New York
ⁿ Sydney Melanoma Diagnostic Centre, Royal Prince Alfred Hospital, and Discipline of Dermatology, University of Sydney, Sydney, Australia
^o Department of Dermatology and Venereology, Sahlgrenska University Hospital, Institute of Clinical Sciences at the Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
^p Skin and Cancer Associates, Plantation, Florida
^q Center for Medical Statistics, Informatics and Intelligent Systems, Medical University of Vienna, Vienna, Austria
^r Department of Dermatology, Chaim Sheba Medical Center, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
^s Dermatology Research Centre, The University of Queensland, The University of Queensland Diamantina Institute, Translational Research Institute, Brisbane, Australia
^t Department of Dermatology, Centre Hospitalier Lyon Sud, Lyon 1 University, Lyons Cancer Research Center, Lyon, France
^u Department of Dermatology, Medical University of Graz, Graz, Austria

^∗Correspondence to: Harald Kittler, MD, Department of Dermatology, Division of General Dermatology, Medical University of Vienna, Währinger Gürtel 18-20, 1090 Vienna, Austria.Department of DermatologyDivision of General DermatologyMedical University of ViennaWähringer Gürtel 18-20Vienna1090Austria

Abstract

Background

Nonpigmented skin cancer is common, and diagnosis with the unaided eye is error prone.

Objective

To investigate whether dermatoscopy improves the diagnostic accuracy for nonpigmented (amelanotic) cutaneous neoplasms.

Methods

We collected a sample of 2072 benign and malignant neoplastic lesions and inflammatory conditions and presented close-up images taken with and without dermatoscopy to 95 examiners with different levels of experience.

Results

The area under the curve was significantly higher with than without dermatoscopy (0.68 vs 0.64, P < .001). Among 51 possible diagnoses, the correct diagnosis was selected in 33.1% of cases with and 26.4% of cases without dermatoscopy (P < .001). For experts, the frequencies of correct specific diagnoses of a malignant lesion improved from 40.2% without to 51.3% with dermatoscopy. For all malignant neoplasms combined, the frequencies of appropriate management strategies increased from 78.1% without to 82.5% with dermatoscopy.

Limitations

The study deviated from a real-life clinical setting and was potentially affected by verification and selection bias.

Conclusions

Dermatoscopy improves the diagnosis and management of nonpigmented skin cancer and should be used as an adjunct to examination with the unaided eye.

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Key words : dermatoscopy, dermoscopy, diagnosis, keratinocytic skin cancer, melanoma, nonpigmented skin cancer

Abbreviations used : AUC, CI, IDS

Plan

Methods

Statistical methods

Results

Benign versus malignant nonpigmented lesions

Specific diagnoses

Management decisions

Discussion

	Funding sources: None.
	Disclosure: Dr Soyer is a shareholder of e-derm consult GmbH and MoleMap by Dermatologists Ltd Pty, and he provides teledermatologic reports regularly for both companies. Drs Sinz, Tschandl, Rosendahl, Akay, Argenziano, Blum, Braun, Cabo, Gourhant, Kreusch, Lallas, Lapins, Marghoob, Menzies, Paoli, Rabinovitz, Rinner, Scope, Thomas, Zalaudek, and Kittler have no conflicts of interest to declare.
	Reprints not available from the authors.

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Vol 77 - N° 6

P. 1100-1109 - décembre 2017 Retour au numéro

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Accuracy of dermatoscopy for the diagnosis of nonpigmented cancers of the skin - 23/11/17

Abstract

Background

Objective

Methods

Results

Limitations

Conclusions

Plan

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