Page 30 - Noninvasive Diagnostic Techniques for the Detection of Skin Cancers

Table 2. Algorithms used in dermoscopy
Type of algorithm Description
ABCD rule lesion asymmetry, border, color, differential structure
A(A)BCD lesion asymmetry, (differential structures in ≥1 axis), border, color, differential
structure
ABCDE lesion asymmetry, border, color, differential structure, elevation
A(A)BCDE lesion asymmetry, (differential structures in ≥1 axis), border, color, differential
structure, elevation
7FFM 7 features of melanoma: pseudopods, radial streaming, regression-erythema,
gray-blue veil, non-homogeneity, irregular pigment network, sharp margin
Pattern analysis specific patterns, colors, intensities of pigmentation, configuration, regularity,
characteristics of margin and surface of pigmented lesions
3-point checklist score asymmetry of color/structure, atypical network, blue-white structures
7 point-checklist score atypical pigment network, blue-whitish veil, atypical vascular pattern, irregular
streaks, irregular pigmentation, irregular dots and globules, regression
structures
Menzies score not present: symmetry and single color; at least one feature: blue-white veil,
brown dots, pseudopods, radial streaming, scar-like depigmentation, peripheral
black dots/globules, 5-6 colors, blue/gray dots, broadened network

Training to increase accuracy. Seven studies analyzed pre-post training in the use of
dermoscopy to increase the accuracy of detection of melanoma. Most training programs were
relatively short in duration (1 day to 2 weeks (1 hour per day for 2 weeks in a Web-based
course)) and consisted of didactic sessions and/or interactive sessions with experienced
instructors.

FDA Status
®
The following devices have received Class I FDA approval status: EpiScope Skin Surface
Microscope (Model 47300) [Welch Allyn, USA; decision year 1992], NevoScope (TransLite
USA; decision year 1996), Dermascope (American Diagnostic Corp, USA; decision year 1999),
and MoleMax (Derma Medical Systems; decision year 1999). The following is a Class II device:
®
microDERM (Visiomed AG, USA; decision year 2004).
Summary
Of the 431 abstracts reviewed in this brief, only three were RCTs. Almost all of the primary
studies on dermoscopy were non-randomized. The non-randomized studies tended to focus on
features of dermoscopic image that would be of diagnostic interest; digital dermoscopy and the
use of computer-based analyses; and evaluations of different algorithms and classification
schemes. We did not identify any controlled studies examining the use of dermoscopy to
increase the detection rate of early stage melanoma. The primary studies that reported patient
outcomes largely focused on number of new lesions and how lesions had evolved. No study
reported on how the addition of dermoscopy affected survival from melanoma.
One RCT did compare dermoscopic evaluation and naked-eye examination in 73 primary
care physicians in Italy and Spain and inferred the effect of the addition of dermoscopy on the
likelihood that a primary care physician would fail to refer a patient with suspicious skin lesions
for a second expert opinion. A second RCT of 913 patients in Italy examined the downstream
effect on the number of skin lesion excised for diagnostic verification with the addition of
dermoscopy in a pigmented lesion clinic.

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