Three-point checklist of dermoscopy: an open internet study

Zalaudek, I., Argenziano, G., Soyer, H. P., Corona, R., Sera, F., Blum, A., Braun, R. P., Cabo, H., Ferrara, G., Kopf, A. W., Langford, D., Menzies, S. W., Pellacani, G., Peris, K. and Seidenari, S. (2006) Three-point checklist of dermoscopy: an open internet study. British Journal of Dermatology, 154 3: 431-437. doi:10.1111/j.1365-2133.2005.06983.x

Author Zalaudek, I.
Argenziano, G.
Soyer, H. P.
Corona, R.
Sera, F.
Blum, A.
Braun, R. P.
Cabo, H.
Ferrara, G.
Kopf, A. W.
Langford, D.
Menzies, S. W.
Pellacani, G.
Peris, K.
Seidenari, S.
Title Three-point checklist of dermoscopy: an open internet study
Journal name British Journal of Dermatology   Check publisher's open access policy
ISSN 1365-2133
Publication date 2006-03
Year available 2006
Sub-type Article (original research)
DOI 10.1111/j.1365-2133.2005.06983.x
Volume 154
Issue 3
Start page 431
End page 437
Total pages 7
Place of publication London
Publisher Blackwell
Language eng
Subject 110304 Dermatology
Formatted abstract
In a pilot study, the three-point checklist of dermoscopy has been shown to represent a valid and reproducible tool with high sensitivity for the diagnosis of skin cancer in the hands of a small group of nonexperts.

To re-evaluate these preliminary results in a large number of observers independently from their profession and expertise in dermoscopy.

The study was conducted via the internet to provide worldwide access for participants. After a short web-based tutorial, the participants evaluated dermoscopic images of 165 (116 benign and 49 malignant) skin lesions (15 training and 150 test lesions). For each lesion participants scored the presence of the three-point checklist criteria (asymmetry, atypical network and blue-white structures). Kappa values, odds ratios, sensitivity, specificity and likelihood ratios were estimated.

Overall, 150 participants joined the study. The three-point checklist showed good interobserver reproducibility (kappa value: 0·53). Sensitivity for skin cancer (melanoma and basal cell carcinoma) was 91·0% and this value remained basically uninfluenced by the observers' professional profile. Only 20 participants lacking any experience in dermoscopy performed significantly more poorly, but the sensitivity was still remarkably high (86·7%) when considering that they were untrained novices in dermoscopy. The specificity was 71·9% and was significantly influenced by the profession, with dermatologists performing best.


Our study confirms that the three-point checklist is a feasible, simple, accurate and reproducible skin cancer screening tool.
Keyword Dermoscopy
Pigmented skin lesions
skin cancer
References # 1 Zalaudek I, Ferrara G, Argenziano G et al. Diagnosis and treatment of cutaneous melanoma: a practical guide. Skinmed 2003; 2: 20–31. Links # 2 Holme SA, Varma S, Chowdhury MM, Roberts DL. Audit of a melanoma screening day in the U.K.: clinical results, participant satisfaction and perceived value. Br J Dermatol 2001; 145: 784–8. Links # 3 Hofmann-Wellenhof R, Soyer HP, Richtig E et al. Should dermatologists go public? A skin cancer screening campaign at recreation centers. Arch Dermatol 2000; 136: 938–40. Links # 4 De Rooij MJ, Rampen FH, Schouten LJ, Neumann HA. Total skin examination during screening for malignant melanoma does not increase the detection rate. Br J Dermatol 1996; 135: 42–5. Links # 5 Fiedman RJ, Rigel DS, Kopf AW. Early detection of malignant melanoma: the role of physician examination and self-examination of the skin. CA Cancer J Clin 1985; 35: 130–51. Links # 6 Guibert P, Mollat F, Ligen M, Dreno B. Melanoma screening: report of a survey in occupational medicine. Arch Dermatol 2000; 136: 199–202. Links # 7 Grin CM, Kopf AW, Welkovich B et al. Accuracy in the clincial diagnosis of malignant melanoma. Arch Dermatol 1990; 126: 763–6. Links # 8 Wolf IH, Smolle J, Soyer HP, Kerl H. Sensitivity in the clinical diagnosis of malignant melanoma. Melanoma Res 1998; 8: 425–9. Links # 9 Wolfe JT. The role of screening in the management of skin cancer. Curr Opin Oncol 1999; 2: 123–8. Links # 10 Kenet RO, Fitzpatrick TB. Reducing mortality and morbidity of cutaneous melanoma: a six year plan. B). Identifying high and low risk pigmented lesions using epiluminescence microscopy. J Dermatol 1994; 21: 881–4. Links # 11 Argenziano G, Soyer HP. Dermoscopy of pigmented skin lesions—a valuable tool for early diagnosis of melanoma. Lancet Oncol 2001; 2: 443–9. Links # 12 Kittler H, Pehamberger H, Wolff K, Binder M. Diagnostic accuracy of dermoscopy. Lancet Oncol 2002; 3: 159–65. Links # 13 Soyer HP, Argenziano G, Chimenti S, Ruocco V. Dermoscopy of pigmented skin lesions. Eur J Dermatol 2001; 11: 270–7. Links # 14 Argenziano G, Soyer HP, Chimenti S et al. Dermocopy of pigmented skin lesions: results of a consensus meeting via the internet. J Am Acad Dermatol 2003; 48: 679–93. Links # 15 Binder M, Schwarz M, Winkler A et al. Epiluminescence microscopy. A useful tool for the diagnosis of pigmented skin lesions for formally trained dermatologists. Arch Dermatol 1995; 131: 286–91. Links # 16 Bafounta ML, Beauchet A, Aegerter P, Saiag P. Is dermoscopy (epiluminescence microscopy) useful for the diagnosis of melanoma? Results of a meta-analysis using techniques adapted to the evaluation of diagnostic tests. Arch Dermatol 2001; 137: 1343–50. Links # 17 Soyer HP, Argenziano G, Zalaudek I et al. 3-point checklist of dermoscopy: a new screening method for early detection of melanoma. Dermatology 2004; 208: 27–31. Links # 18 Fleiss JL. Measuring nominal scale agreement among many raters. Psychol Bull 1971; 76: 378–82. Links # 19 Fleiss JL. Statistical Methods for Rates and Proportions. New York: John Wiley & Sons 1981; 212–36. # 20 Fleiss JL, Nee JCM, Landis JR. The large sample variance of kappa in the case of different sets of raters. Psychol Bull 1979; 86: 974–7. Links # 21 Ronco G, Biggeri A. Estimating sensitivity and specificity when repeated tests are performed on the same subject. J Epidemiol Biostat 1999; 4: 329–36. Links # 22 Leisenring W, Pepe MS, Longton G. A marginal regression modelling framework for evaluating medical diagnostic tests. Stat Med 1997; 16: 1263–81. Links # 23 Steiner A, Pehamberger H, Wolff K. In vivo epiluminescence microscopy of pigmented skin lesions. II. Diagnosis of small pigmented skin lesions and early detection of malignant melanoma. J Am Acad Dermatol 1987; 17: 584–91. Links # 24 Argenziano G, Zalaudek I, Soyer HP. Which is the most reliable method for teaching dermoscopy for melanoma diagnosis to residents in dermatology? Br J Dermatol 2004; 150: 512–3. Links # 25 Stolz W, Riemann A, Cognetta AB et al. ABCD rule of dermatoscopy: a new practical method for early recognition of malignant melanoma. Eur J Dermatol 1994; 4: 521–7. Links # 26 Menzies SW, Ingvar C, Crotty KA, McCarthy WH. Frequency and morphologic characteristics of invasive melanomas lacking specific surface microscopic features. Arch Dermatol 1996; 132: 1178–82. Links # 27 Argenziano G, Fabbrocini G, Carli P et al. 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. Arch Dermatol 1998; 134: 1563–70. Links
Q-Index Code C1

Document type: Journal Article
Sub-type: Article (original research)
Collections: Excellence in Research Australia (ERA) - Collection
School of Medicine Publications
Version Filter Type
Citation counts: TR Web of Science Citation Count  Cited 44 times in Thomson Reuters Web of Science Article | Citations
Scopus Citation Count Cited 46 times in Scopus Article | Citations
Google Scholar Search Google Scholar
Created: Thu, 22 Jan 2009, 10:46:54 EST by Marianne Steentsma on behalf of School of Medicine