Improvement of diagnostic accuracy in clinical diagnosis of pigmented skin lesions by using dermatoscopy

BACKGROUND The use of mobile electronic devices as support to medical activity was largely implemented in the last decade. Teledermatology proved to be effective in the triage of patients with pigmented skin lesions. Dermosocpic algorithms were developed to help dermatologists in the non-invasive diagnosis of difficult melanocytic skin lesions, but they were not yet tested in a tele-dermoscopy web platform setting. OBJECTIVE To evaluate the frequency and feasibility of different electronic devices (personal computer, notebook, tablet, smartphone) in multiple teledermoscopic testing sessions on a teledermatology web platform (TWP) over clinically and dermoscopically difficult melanocytic skin lesions (MSLs). METHODS The devices’ technical characteristics were recorded, along with the diagnostic performances of 111 dermatologists with different experience in dermoscopy. They gave both intuitive diagnosis (i.e., pattern analysis) and algorithm-assisted diagnoses (i.e., iDScore, ABCD rule, 7-point-checklist) on standardized images of difficult MSLs blinded cases. RESULTS Young generation of dermoscopists are more prone to alternately use different devices, while elderly generation still prefer to use the pc. There was no difference in the diagnostic performances obtained with small/large screen or fixed/mobile devices, either in intuitive diagnosis (AUC=0.666 with fixed, AUC=0.688 with portable) and in algorithm-assisted diagnosis (e.g, iDScore method; AUC=0.766 with fixed, AUC=0.785 with portable). The overall highest AUC (AUC=0,82) was obtained by young generation dermoscopists (level I+II) when using the iDscore-assisted diagnosis on a notebook. CONCLUSIONS The tele-dermoscopic diagnostic accuracy on difficult MSLs cases adequately selected for image quality and homogenous standard seems not to be negatively affected by using different electronic devices. Using this TWP with both educational and testing purposes enabled participants of different experience to achieve adequate diagnostic accuracy in difficult MSLs, especially with iDScore-assisted diagnosis.

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Diagnostic Concordance in Tertiary (Dermatologists-to-Experts) Teledermoscopy: A Final Diagnosis-Based Study on 290 Cases

Dermatology Practical & Conceptual ◽

10.5826/dpc.1003a71 ◽

2020 ◽

pp. e2020071 ◽

Cited By ~ 1

Author(s):

Anne Marchetti ◽

Stephane Dalle ◽

Delphine Maucort Boulch ◽

Mona Amini-Adl ◽

Sébastien Debarbieux ◽

...

Keyword(s):

Diagnostic Accuracy ◽

Real Life ◽

Final Diagnosis ◽

Skin Lesions ◽

Real Life Setting ◽

Retrospective Nature ◽

Pigmented Skin Lesions ◽

Diagnostic Concordance ◽

Difficult Cases

Background: Teledermoscopy (TDS) improves diagnostic accuracy and decreases the number of unnecessary consultations. Objectives: To determine the diagnostic concordance in tertiary (dermatologist-to-experts) TDS with histopathology/follow-up–based diagnosis. Methods: A descriptive retrospective cohort study including 290 requests. Results: Perfect diagnostic concordance was found in 202 (69.7%) cases and partial agreement in 29 (10%). Disagreement was found in 59 (20.3%) cases. Perfect concordance on the benign/malignant nature of the lesion was found in 227 (78.3%) cases and disagreement in 63 (21.7%). In onychology, diagnostic concordance was perfect in 43 (76.8%) cases, partial in 7 (12.5%), and there was disagreement in 6 (10.7%). Final concordance on the benign/malignant nature of the lesion was perfect in 48 (85.7%) and there was disagreement in 8 (14.3%) nail cases. For pediatric requests, diagnostic concordance was perfect in 29 (65.9%) cases, partial in 5 (11.4%), and there was disagreement in 10 (22.7%). Final concordance on the benign/malignant nature of the lesion was observed in 34 (77.3%) cases, disagreement in 10 (22.7%). Conclusions: This study confirms that tertiary TDS improves diagnostic accuracy of pigmented skin lesions. Moreover, it shows encouraging results in unusual conditions such as ungual and pediatric skin tumors. The main limitation was the retrospective nature and the “real-life” setting of our study that could have created a selection bias toward inclusion of the most difficult cases.

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The diagnostic accuracy of Danish GPs in the diagnosis of pigmented skin lesions

Family Practice ◽

10.1093/fampra/16.6.619 ◽

1999 ◽

Vol 16 (6) ◽

pp. 619-620 ◽

Cited By ~ 3

Author(s):

G. B. Jemec

Keyword(s):

Diagnostic Accuracy ◽

Skin Lesions ◽

Pigmented Skin Lesions

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COMMON PIGMENTED SKIN LESIONS

The Professional Medical Journal ◽

10.29309/tpmj/2018.25.01.542 ◽

2018 ◽

Vol 25 (01) ◽

pp. 78-83

Author(s):

Amjad Ali Khan ◽

Abdul Shaheed Asghar ◽

Israr Ahmed Akhund ◽

Muhammad Ishaq

Keyword(s):

Clinical Diagnosis ◽

Malignant Tumors ◽

Skin Lesions ◽

Melanocytic Nevus ◽

Seborrheic Keratosis ◽

Melanocytic Nevi ◽

Medical College ◽

Hematoxylin And Eosin ◽

Pigmented Skin Lesions ◽

Year 2013

Objectives: The purpose of this study is; firstly, to study the histopathologicalspectrum of the pigmented skin lesions in the community, to signify that not all pigmented skinlesions are malignant melanomas; secondly, to assess the age-wise distribution of the commonpigmented skin lesions; and thirdly, to determine the commonly affected body sites by thesepigmented skin lesions. Study Design: Retrospective/Observational study. Setting: CharsadaTeaching Hospital affiliated with Jinnah Medical College Peshawar. Period: 100 consecutivecases with clinical diagnosis of pigmented skin lesion, starting in the year 2013. Methods: Inthis study, 100 consecutive surgical pathology cases with clinical diagnosis of pigmented skinlesion were retrieved from the archives of Charsada Teaching Hospital affiliated with JinnahMedical College Peshawar. All the specimens were incisional biopsies of skin, fixed in 10%formalin, embedded in paraffin, and stained with Hematoxylin and Eosin stains. Results: Onanalyzing 100 consecutive pigmented skin lesions (n=100) starting from the year 2013, it wasfound thatthe large majority of these lesions were benign. The most common pigmented skinlesion was melanocytic nevus. Moreover, majority of pigmented skin lesions were seen infemales. Seborrheic keratosis and malignant tumors, like basal cell carcinoma and squamouscell carcinomas, were more commonly seen in males in the 6th and 7th decades of life; whereas,dermatofibroma and post-inflammatory pigmentation were more common in females in the 4thand 5th decades of life. Overall, the pigmented skin lesions were more common in the 3rd, 4th, and5th decades of life with peak in the 4th decade. Skin of face was the most common site affectedby melanocytic nevi and malignant epidermal skin tumors. Conclusions: In conclusion, mostof the pigmented skin lesions are benign, encountered in the 4th decade of life, and commonlyaffect the skin of face. Also, most of the melanocytic nevi are encountered in females, whilemost of the malignant epidermal neoplasms are encountered in males affecting the skin of face.

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