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Accuracy of dermatoscopy for the diagnosis of nonpigmented cancers of the skin

Published:September 20, 2017DOI:https://doi.org/10.1016/j.jaad.2017.07.022

      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.

      Key words

      Abbreviations used:

      AUC (area under the curve), CI (confidence interval), IDS (International Society of Dermoscopy)
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