Accuracy in the clinical diagnosis of malignant melanoma

Grin, Caron M.

doi:10.1001/archderm.126.6.763

Cited by 178 publications

(33 citation statements)

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“…For example, in a retrospective study of 4,741 pigmented skin lesions evaluated by 468 general practitioners, the biopsy ratio, defined as the number of nonmelanoma lesions that underwent biopsy for each confirmed case of melanoma ranged from 58:1 to 21:1 for new versus experienced general practitioners, respectively (1). A number of studies have shown that the accuracy of clinical diagnosis of melanoma by dermatologists varies between 49% and 81%, with approximately one third of melanomas being misdiagnosed as benign lesions (2)(3)(4)(5)(6).…”

Section: Introductionmentioning

confidence: 99%

Real-time Raman Spectroscopy for In Vivo Skin Cancer Diagnosis

et al. 2012

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Raman spectroscopy is a noninvasive optical technique capable of measuring vibrational modes of biomolecules within viable tissues. In this study, we evaluated the application of an integrated real-time system of Raman spectroscopy for in vivo skin cancer diagnosis. Benign and malignant skin lesions (n ¼ 518) from 453 patients were measured within 1 second each, including melanomas, basal cell carcinomas, squamous cell carcinomas, actinic keratoses, atypical nevi, melanocytic nevi, blue nevi, and seborrheic keratoses. Lesion classification was made using a principal component with general discriminant analysis and partial least-squares in three distinct discrimination tasks: skin cancers and precancers from benign skin lesions [receiver operating characteristic (ROC) ¼ 0.879]; melanomas from nonmelanoma pigmented lesions (ROC ¼ 0.823); and melanomas from seborrheic keratoses (ROC ¼ 0.898). For sensitivities between 95% and 99%, the specificities ranged between 15% and 54%. Our findings establish that real-time Raman spectroscopy can be used to distinguish malignant from benign skin lesions with good diagnostic accuracy comparable with clinical examination and other opticalbased methods. Cancer Res; 72(10); 2491-500. Ó2012 AACR.

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Section: Introductionmentioning

confidence: 99%

Real-time Raman Spectroscopy for In Vivo Skin Cancer Diagnosis

et al. 2012

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“…The clinical diagnostic accuracy of physicians, however, is less than perfect (1). The search for new methods that may aid in the early detection of melanomas has led to the development of novel imaging modalities, such as computer-assisted image analysis (2), dermoscopy (3), and confocal scanning laser microscopy (CSLM; 4,5).…”

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confidence: 99%

Morphologic Features of Melanocytes, Pigmented Keratinocytes, and Melanophages by In Vivo Confocal Scanning Laser Microscopy

et al. 2001

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Confocal scanning laser microscopy (CSLM) represents a novel imaging technique for in vivo microscopic analysis of skin lesions at a level of resolution that allows morphologic analysis of microanatomic structures. We investigated the feasibility of recognizing the cellular constituents of pigmented skin lesions, such as pigmented keratinocytes, melanocytes, and melanophages, by CSLM. Fifteen pigmented lesions (five pigmented seborrheic keratoses, and 10 compound melanocytic nevi) from 15 patients were studied, as well as normal skin. After the clinical lesions were imaged by CSLM, they were biopsied or excised for examination by conventional histology for comparison of the morphologic features. In images obtained by CSLM, pigmented keratinocytes were seen as polygonal cohesive cells with variably bright granular cytoplasm. Melanocytes appeared as bright round, oval, fusiform, or dendritic cells. The architectural growth pattern of melanocytes could be analyzed. Melanocytes were identified by their nested growth pattern as aggregates of bright round to oval structures at the dermoepidermal junction or in the superficial dermis. Melanocytes were also recognizable as single cells along the dermoepidermal junction, usually separated from each other by a variable number of keratinocytes. Melanophages appeared as large bright plump cells with ill-defined cytoplasmic borders, usually located around or near vessels of the superficial dermis. Our results demonstrate that the cellular constituents of pigmented lesions can be recognized by CSLM. This technique sets a new paradigm for noninvasive quasihistologic examination of pigmented lesions in vivo and merits further evaluation for diagnostic use.

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“…Reports assessing diagnostic accuracy based on clinical criteria alone have shown that dermatologists are able to detect melanoma in 65-80% of cases. [1][2][3] Therefore, 20-35% of melanomas escape from clinical diagnosis. To improve the preoperative diagnosis of melanoma, dermoscopy (dermatoscopy, skin surface microscopy, epiluminescence microscopy- [ELM]) has been increasingly used in clinical practice.…”

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confidence: 99%

Dermoscopic and histopathologic diagnosis of equivocal melanocytic skin lesions

Ferrara

Argenziano

Soyer

et al. 2002

Cancer

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BACKGROUNDDermoscopy (dermatoscopy, epiluminescence microscopy) is increasingly employed for the preoperative detection of cutaneous melanoma; dermoscopic features of pigmented skin lesions have been previously defined using histopathology as the key to the code. In a preliminary study on 10 cases evaluated by nine dermoscopists and nine histopathologists, the authors experienced that when at least two dermoscopists disagree in evaluating a melanocytic lesion, even histopathologic consultations may give equivocal results.METHODSOne hundred seven melanocytic skin lesions, consecutively excised because of equivocal clinical and/or dermoscopic features, were retrospectively examined by eight dermoscopists and eight histopathologists; the diagnostic interobserver agreement was calculated by means of the Schouten k statistics. After histopathologic consultations, all 107 lesions underwent unblinded dermoscopic re‐evaluation in order to find which dermoscopic features had given rise to histopathologic diagnostic difficulties.RESULTSThe interobserver ageement was good for both dermoscopy (k = 0.53) and histopathology (k = 0.74). Out of 48 cases evaluated by the dermoscopists in complete accordance, only 8 (16.7%) received at least one conflicting histopathologic diagnosis. Instead, among the remaining 59 cases with at least one disagreeing dermoscopic diagnosis, 21 (35.6%) received at least one disagreeing histopathologic diagnosis. The unblinded dermoscopic re‐evaluation showed that five out of seven lesions with clear‐cut regression structures were histopathologically controversial.CONCLUSIONSAt least for selected and reasonably difficult lesions, a diagnostic discrepancy among formally trained dermoscopists seems to be predictive for a diagnostic disagreement among histopathologists. Lesions showing clear‐cut regression structures are prone to give some histopathologic disagreement. Cancer 2002;95:1094–1100. © 2002 American Cancer Society.DOI 10.1002/cncr.10768

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Accuracy in the clinical diagnosis of malignant melanoma

Cited by 178 publications

References 0 publications

Real-time Raman Spectroscopy for In Vivo Skin Cancer Diagnosis

Real-time Raman Spectroscopy for In Vivo Skin Cancer Diagnosis

Morphologic Features of Melanocytes, Pigmented Keratinocytes, and Melanophages by In Vivo Confocal Scanning Laser Microscopy

Dermoscopic and histopathologic diagnosis of equivocal melanocytic skin lesions

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