Test 63. VI+dermoscopy (in-person) -high experience (invasive melanoma or atypical intraepidermal melanocytic variants)...... Test 65. VI+dermoscopy (in-person) -trained observer (invasive melanoma or atypical intraepidermal melanocytic variants)..... Dermoscopy, with and without visual inspection, for diagnosing melanoma in adults (Review)

The value of a diagnostic test is not simply measured by its accuracy, but depends on how it affects patient health. This article presents a framework for the design and interpretation of studies that evaluate the health consequences of new diagnostic tests Most studies of diagnostic tests evaluate only their accuracy. Although such studies describe how well tests identify patients with disease (sensitivity) or without disease (specificity), further evidence is needed to determine a test's true clinical value. Firstly, since tests are rarely used in isolation, studies are needed that evaluate the performance of testing strategies, accounting for when and how a new test is used within a diagnostic pathway, and how its findings are combined with results of other tests.1 Secondly, decision making involves selecting among multiple testing strategies; thus studies that compare test strategies and estimate differences in sensitivity and specificity are more informative than those that evaluate the accuracy of one test or diagnostic strategy.2 Thirdly, improvements in test accuracy will not benefit patients unless they lead to changes in diagnoses and patient management, requiring evaluations of the effect of improved accuracy on decision making.3 Finally, improved decision making is only one route by which tests affect patient health, and empirical evaluations are needed to compare the effect of test strategies on patient health. 4 Ideally, new tests should only be introduced into clinical practice if evidence indicates that they have a better chance of improving patient health than existing tests.5 6 Tests can be compared by evaluating the downstream consequences of testing on patient outcomes, either directly in a randomised controlled trial or by decision analysis models that integrate multiple sources of evidence. Test-treatment trials randomly allocate patients to tests, follow up subsequent management, and measure outcomes only after treatment has been received ( fig 1⇓). 7 Decision models use existing clinical data to extrapolate, through a number of assumptions, the link between intermediate outcomes (such as accuracy) and long term outcomes. 8 A key issue for trials and decision models is the selection of outcomes that need to be measured or modelled to evaluate how tests are affecting patients. This selection requires a priori knowledge of the mechanisms by which tests affect patient health.In this article, we provide a comprehensive review of the mechanisms that can drive changes to patient health from testing, and include a summary checklist to assist readers, researchers, and funders who wish to design or appraise studies evaluating diagnostic tests. We have based our framework on a review of a large cohort of published test-treatment trials 9 and key methodological literature. Effect of tests on patient healthTo establish whether a new diagnostic test will change health outcomes, it must be examined as part of a broader management strategy. Testing represents the first step of a test-treatment process...

Background Early accurate detection of all skin cancer types is essential to guide appropriate management and to improve morbidity and survival. Melanoma and squamous cell carcinoma (SCC) are high-risk skin cancers, which have the potential to metastasise and ultimately lead to death, whereas basal cell carcinoma (BCC) is usually localised, with potential to infiltrate and damage surrounding tissue. Anxiety around missing early cases needs to be balanced against inappropriate referral and unnecessary excision of benign lesions. Optical coherence tomography (OCT) is a microscopic imaging technique, which magnifies the surface of a skin lesion using near-infrared light. Used in conjunction with clinical or dermoscopic examination of suspected skin cancer, or both, OCT may offer additional diagnostic information compared to other technologies. Objectives To determine the diagnostic accuracy of OCT for the detection of cutaneous invasive melanoma and atypical intraepidermal melanocytic variants, basal cell carcinoma (BCC), or cutaneous squamous cell carcinoma (cSCC) in adults.

Computer-assisted diagnosis techniques (dermoscopy and spectroscopy-based) for diagnosing skin cancer in adults.

Background Melanoma has one of the fastest rising incidence rates of any cancer. It accounts for a small percentage of skin cancer cases but is responsible for the majority of skin cancer deaths. History-taking and visual inspection of a suspicious lesion by a clinician is usually the first in a series of 'tests' to diagnose skin cancer. Establishing the accuracy of visual inspection alone is critical to understating the potential contribution of additional tests to assist in the diagnosis of melanoma. Objectives To determine the diagnostic accuracy of visual inspection for the detection of cutaneous invasive melanoma and atypical intraepidermal melanocytic variants in adults with limited prior testing and in those referred for further evaluation of a suspicious lesion. Studies were separated according to whether the diagnosis was recorded face-to-face (in-person) or based on remote (image-based) assessment.