Influence of time on dermoscopic diagnosis and management

Jaimes, Natalia, Dusza, Stephen W., Quigley, Elizabeth A., Braun, Ralph P., Puig, Susana, Malvehy, Josep, Kittler, Harald, Rabinovitz, Harold S., Oliviero, Margaret C., Soyer, H. Peter, Grichnik, James M., Korzenko, Adam, Cabo, Horacio, Carlos-Ortega, Blanca, Ahlgrimm-Siess, Verena, Kopf, Alfred W. and Marghoob, Ashfaq A. (2013) Influence of time on dermoscopic diagnosis and management. Australasian Journal of Dermatology, 54 2: 96-104. doi:10.1111/ajd.12001

Author Jaimes, Natalia
Dusza, Stephen W.
Quigley, Elizabeth A.
Braun, Ralph P.
Puig, Susana
Malvehy, Josep
Kittler, Harald
Rabinovitz, Harold S.
Oliviero, Margaret C.
Soyer, H. Peter
Grichnik, James M.
Korzenko, Adam
Cabo, Horacio
Carlos-Ortega, Blanca
Ahlgrimm-Siess, Verena
Kopf, Alfred W.
Marghoob, Ashfaq A.
Title Influence of time on dermoscopic diagnosis and management
Journal name Australasian Journal of Dermatology   Check publisher's open access policy
ISSN 0004-8380
Publication date 2013-05
Year available 2012
Sub-type Article (original research)
DOI 10.1111/ajd.12001
Volume 54
Issue 2
Start page 96
End page 104
Total pages 9
Place of publication Richmond, Vic., Australia
Publisher Wiley-Blackwell Publishing
Collection year 2013
Language eng
Formatted abstract
Background/Objectives: Dermoscopy aids in clinical decision-making. However, time pressure is a common reason precluding its use. We evaluated the effect of time on lesion recognition and management decisions utilising clinical and dermoscopic images.
Method: In all, 100 dermoscopic images were presented to 15 dermatologists with experience in dermoscopy and seven non-experts (dermatology residents). Each lesion was displayed thrice in succession. The dermoscopic image was initially presented for 1 s (t1). The same dermoscopic image was shown again without time constraints (t2) and then a final time with additional images of the clinical context (t3). Participants provided a diagnosis, their level of confidence and biopsy predilection after evaluating each image.
Results: For benign lesions, both groups rarely changed their diagnosis. However, an improvement in the number of correct benign diagnoses was observed when the lesion was shown in a clinical context. For malignant lesions, both groups improved when more time and clinical context was given; nevertheless, non-experts were more likely to change the diagnosis towards the correct one as more time was given and tended to perform more biopsies, in particular of benign lesions. Limitations were a small number of participants and an artificial study setting.
Conclusion: Dermoscopy uses analytical and non-analytical reasoning approaches. We suggest that non-analytical reasoning is employed when rapid clinical decisions need to be made, especially during the evaluation of benign lesions. We conclude that dermoscopy is relatively rapid and non–time-consuming technique that adds relevant information and guides clinicians towards appropriate management decisions.
Keyword Clinical reasoning
Decision-making process
Q-Index Code C1
Q-Index Status Confirmed Code
Institutional Status UQ
Additional Notes Article first published online: 29 NOV 2012

Document type: Journal Article
Sub-type: Article (original research)
Collections: Official 2013 Collection
School of Medicine Publications
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Citation counts: TR Web of Science Citation Count  Cited 8 times in Thomson Reuters Web of Science Article | Citations
Scopus Citation Count Cited 9 times in Scopus Article | Citations
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Created: Sun, 14 Apr 2013, 11:48:26 EST by Nicole Lin on behalf of Medicine - Princess Alexandra Hospital