Page 41 - Noninvasive Diagnostic Techniques for the Detection of Skin Cancers

Any new trials in the United States investigating the benefit of dermoscopy compared with naked
eye examination in affecting health outcomes will have to take into account this heterogeneity.
Similarly, dermatologists are the primary users of confocal scanning laser microscopy
(CSLM), which aids in the evaluation of skin lesions by providing high resolution skin tissue
images that are similar to histopathological images. The high cost of confocal microscopes is an
obstacle to the widespread diffusion of this technique. There are no trials comparing CSLM with
the use of other diagnostic techniques (such as clinical examination or dermoscopy). Reported
outcomes in cohort studies mainly focused on lesion characterizations by CSLM and its test
accuracy.
While numerous other modalities, including high frequency ultrasound/Doppler and PDD,
are available, their use is still limited in clinical practice, and several, such as multiphoton
microscopy, bio-electrical impedance, OCT, tape stripping, multispectral imaging and fully
automated computer-based analysis, and thermography, are considered investigational. There are
virtually no trials that compare their accuracy and patient outcomes with conventional
histological determination. Test accuracy of many of these investigational modalities has not
been adequately assessed. It is unclear whether these modalities perform better in diagnosing
certain types of skin cancer or among subgroups of patients, such as specific ethnic/racial groups
or history of prior cancer (skin or other site). In addition, evidence supporting the use of these
investigational modalities to replace further diagnostic evaluation is lacking. Little to no data was
available to assess the safety and potential harms related to the use of these technologies.
Research on the use, diffusion, and training of different modalities has yet to be conducted. In
summary, for most of these technologies, the abstracts we identified addressed their technical
efficacy and/ or diagnostic accuracy efficacy, leaving unanswered questions enumerated above.

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