Elsevier

The Lancet Oncology

Volume 3, Issue 3, March 2002, Pages 159-165
The Lancet Oncology

Review
Diagnostic accuracy of dermoscopy

https://doi.org/10.1016/S1470-2045(02)00679-4Get rights and content

Summary

The accuracy of the clinical diagnosis of cutaneous melanoma with the unaided eye is only about 60%. Dermoscopy, a non-invasive, in vivo technique for the microscopic examination of pigmented skin lesions, has the potential to improve the diagnostic accuracy. Our objectives were to review previous publications, to compare the accuracy of melanoma diagnosis with and without dermoscopy, and to assess the influence of study characteristics on the diagnostic accuracy. We searched for publications between 1987 and 2000 and identified 27 studies eligible for meta-analysis. The diagnostic accuracy for melanoma was significantly higher with dermoscopy than without this technique (log odds ratio 4·0 [95% CI 3·0 to 5·1] versus 2·7 [1·9 to 3·4]; an improvement of 49%, p = 0·001). The diagnostic accuracy of dermoscopy significantly depended on the degree of experience of the examiners. Dermoscopy by untrained or less experienced examiners was no better than clinical inspection without dermoscopy. The diagnostic performance of dermoscopy improved when the diagnosis was made by a group of examiners in consensus and diminished as the prevalence of melanoma increased. A comparison of various diagnostic algorithms for dermoscopy showed no significant differences in their diagnostic performance. A thorough appraisal of the study characteristics showed that most of the studies were potentially influenced by verification bias. In conclusion, dermoscopy improves the diagnostic accuracy for melanoma in comparison with inspection by the unaided eye, but only for experienced examiners.

Section snippets

Methods

Eligible studies (see Search strategy and selection criteria) were classified, with no masking, by two readers in consensus on prospectively defined characteristics important for assessment of diagnostic tests. The following information was extracted from each report: authors' names; year of publication; description of pigmented skin lesions (melanoma prevalence, melanoma invasion thickness, frequency of non-melanocytic lesions); experience of examiners; independence of clinical and

Statistical analysis

Sensitivity and specificity were calculated according to standard formulae. When individual assessments from several observers were given in a study, the median values of the sensitivity and specificity were used in our analysis. Least-squares linear regression was used to estimate parameters for summary receiver-operating-characteristic (SROC) models. Estimates of sensitivity and specificity were obtained from each study and used to calculate their log odds ratio (logit), which measures how

Study characteristics

The main characteristics of each of the 27 eligible studies4, 5, 6, 10, 11, 12, 13, 17, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28, 29, 30, 31, 32, 33, 34, 35, 36 are presented in Table 1. The pooled sample was 9821 pigmented skin lesions (median per study 232). The prevalence of melanoma ranged from 1·6% to 60·8% (mean 28·3%). The mean or median Breslow thickness was reported in 15 studies and ranged from 0·40 mm to 1·11 mm (median 0·70 mm).

In most of the available studies, all lesions were

Discussion

This meta-analysis of 27 studies provides evidence that dermoscopy gives better diagnostic accuracy for melanoma than clinical inspection without dermatoscopy (ie with the unaided eye). This conclusion accords with that of a previous review, which included six studies,37 and another meta-analysis, which included eight studies.38 The review did not provide a quantitative analysis and the other metaanalysis was restricted to studies that directly compared the diagnostic performance with and

Conclusion

Dermoscopy improves the diagnostic accuracy for melanoma in comparison with inspection by the unaided eye. However, dermoscopy requires sufficient training and cannot be recommended for untrained users. A consensus diagnosis involving two or more experts is recommended to yield the highest possible diagnostic accuracy.

Search strategy and selection criteria

Relevant studies were identified and retrieved by a search of MEDLINE for the period January 1987 to December 2000, by manual searches of the reference lists of retrieved articles, and by direct communication with experts on this topic. The terms “epiluminescence”, “dermoscopy”, “dermatoscopy”, and “incident light microscopy” were linked with a Boolean OR operator and the search yielded 157 articles. 116 articles were excluded at this stage: those that were not relevant to the topic, did

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