Pre-operative diagnosis of pigmented skin lesions: in vivo dermoscopy performs better than dermoscopy on photographic images

Carli, P., De Giorgi, V., Argenziano, G., Palli, D. and Giannotti, B. (2002) Pre-operative diagnosis of pigmented skin lesions: in vivo dermoscopy performs better than dermoscopy on photographic images. Journal of the European Academy of Dermatology and Venereology, 16 4: 339-346. doi:10.1046/j.1468-3083.2002.00470.x

Author Carli, P.
De Giorgi, V.
Argenziano, G.
Palli, D.
Giannotti, B.
Title Pre-operative diagnosis of pigmented skin lesions: in vivo dermoscopy performs better than dermoscopy on photographic images
Journal name Journal of the European Academy of Dermatology and Venereology   Check publisher's open access policy
ISSN 0926-9959
Publication date 2002-01-01
Sub-type Article (original research)
DOI 10.1046/j.1468-3083.2002.00470.x
Open Access Status
Volume 16
Issue 4
Start page 339
End page 346
Total pages 7
Place of publication Amsterdam ; New York
Publisher Blackwell
Language eng
Subject 110304 Dermatology
Abstract BackgroundEpiluminescence microscopy (ELM) (dermoscopy, dermatoscopy) is a technique for non-invasive diagnosis of pigmented skin lesions that improves the diagnostic performance of dermatologists. Little is known about the possible influence of associated clinical features on the reliability of dermoscopic diagnosis during in vivo examination. ObjectiveTo compare diagnostic performance of in vivo dermoscopy (combined clinical and dermoscopic examination) with that of dermoscopy performed on photographic slides (pure dermoscopy). DesignThis case series comprised 256 pigmented skin lesions consecutively identified as suspicious or equivocal during examination in a general dermatological clinic. Clinical examination and in vivo dermoscopy were performed before excision by two trained dermatologists. The same observers carried out dermoscopy on photographic slides at a later time, and these three diagnostic classifications were reviewed together with the histological findings for the individual lesions. This was carried out in a university hospital. Results In vivo dermoscopy performed better than dermoscopy on photographic slides for classification of pigmented skin lesions compared with histological diagnosis, and both performed better than general clinical diagnosis. In vivo dermoscopic diagnosis of melanoma showed 98.1% sensitivity, 95.5% specificity and 96.1% diagnostic accuracy while dermoscopic diagnosis of melanoma on photographic slides was less reliable with 81.5% sensitivity, 86.7% specificity and 85.2% diagnostic accuracy. In particular, diagnosis of melanoma based on photographic slides led to nine false negative cases (three in situ , six invasive; thickness ranges 0.2–1.5 mm). Conclusions In vivo dermoscopy, i.e. combined clinical and dermoscopic examination, is more reliable than dermoscopy on photographic slides. In clinical practice, therefore, in vivo dermoscopy cannot be considered independent from associated clinical characteristics of the lesions, which help the trained observer to reach a more precise classification. This may have implications on the reliability of ELM diagnosis made by an observer not fully trained in the clinical diagnosis of pigmented skin lesions or by a remote observer during digital ELM teleconsultation.
Keyword dermatoscopy
epiluminescence microscopy
melanocytic naevi
Q-Index Code C1
Q-Index Status Provisional Code
Institutional Status Unknown

Document type: Journal Article
Sub-type: Article (original research)
Collections: Excellence in Research Australia (ERA) - Collection
School of Medicine Publications
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Created: Thu, 02 Apr 2009, 02:07:10 EST by Sophie Jordan on behalf of School of Medicine