Page 29 - Noninvasive Diagnostic Techniques for the Detection of Skin Cancers

individual risk profile of a patient (e.g., familial atypical mole and multiple melanoma
(FAMMM) syndrome, atypical mole syndrome (AMS), previous melanoma), would be effective
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in detecting melanoma.
One study evaluated the following factors associated with the use of dermoscopy: sex and
age of dermatologists, teaching setting, years graduated from residency, and patients’ geographic
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residence. Reimbursement issues may limit its widespread use. Marchionda 2010 indicated that
the lack of reimbursement from an insurance company would result in unwillingness to use
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dermoscopy among U.S. practitioners.
One cohort study on non-whites in Brazil evaluated the effectiveness of dermoscopy in
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individuals with darker pigmentation.

Primary Care Setting
One study examined the difference in accuracy between dermatologists and primary care
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physicians in diagnosing melanoma. One RCT evaluated the effect of training versus no
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training in the use of dermoscopy in primary care physicians. One nonrandomized intervention
study evaluated the effect of training primary care physicians in the use of dermoscopy and
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short-term sequential digital dermoscopy.
Although dermoscopy has not been evaluated for patient self use, a recent report described
two patients who used dermoscopy themselves to help identify suspicious skin lesions during
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skin self-examination.
Diagnostic Accuracy
A total of 86 primary studies and five systematic reviews evaluated general and digital
dermoscopy; specific dermoscopic image features; particular classification schemes and/or
algorithms; teledigital dermoscopy; and/or computer-aided analyses for diagnostic accuracy.
One systematic review compared the diagnostic odds ratios for melanoma across the different
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algorithms of dermoscopy. (Table 1) Three systematic reviews investigated the diagnostic
accuracy of dermoscopy compared with naked eye examination for melanoma. 76-78 Most of the
primary studies did not address the issue of potential verification bias as it was likely that only
those patients with clinically suspicious lesions received biopsies. One systematic review
examined the diagnostic accuracy of conventional dermoscopy compared with computer-aided
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dermoscopy for the diagnosis of melanoma.

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