BLINCK—A diagnostic algorithm for skin cancer diagnosis combining clinical features with dermatoscopy findings

Abstract

Background:Deciding whether a skin lesion requires biopsy to exclude skin cancer is often challenging for primary care clinicians in Australia. There are several published algorithms designed to assist with the diagnosis of skin cancer but apart from the clinical ABCD rule, these algorithms only evaluate the dermatoscopic features of a lesion.Objectives:The BLINCK algorithm explores the effect of combining clinical history and examination with fundamental dermatoscopic assessment in primary care skin cancer practice.Patients/Methods:Clinical and dermatoscopic images of 50 skin lesions were collected and shown to four primary care practitioners. The cases were assessed by each participant and lesions requiring biopsy were determined on separate occasions using the 3-Point Checklist, the Menzies method, clinical assessment alone and the BLINCK algorithm.Results:The BLINCK algorithm had the highest sensitivity and found more melanomas than any of the other methods. However, BLINCK required more biopsies than the other methods. When comparing diagnostic accuracy, there was no difference between BLINCK, Menzies method and clinical assessment but all were better than the 3-Point checklist.Conclusions:These results suggest that the BLINK algorithm may be a useful skin cancer screening tool for Australian primary care practice.

Patient concern as a predictor of cutaneous malignancy

“…It is possible that patients subconsciously perceive subtle changes that they are otherwise unable to communicate . Patients know more than they verbalize, and may summarize this by acknowledging concern, requesting a biopsy or appearing nervous . In our study, six of 144 (4·2%) patients with invasive melanoma and 17 of 223 (7·6%) with in situ melanoma exhibited concern when melanoma was not on the physician's differential diagnosis.…”

“…4 Patients know more than they verbalize, and may summarize this by acknowledging concern, requesting a biopsy or appearing nervous. 6 In our study, six of 144 (4Á2%) patients with invasive melanoma and 17 of 223 (7Á6%) with in situ melanoma exhibited concern when melanoma was not on the physician's differential diagnosis. This proportion supports the 6Á0% of patients with melanoma in a study by Gachon et al for whom seemingly benign lesions 'were removed only to reassure the patient', yet were histopathologically diagnosed as melanoma.…”

“…We believe that both change and concern are useful predictors of melanoma, as Bourne et al denoted in their BLINCK algorithm, where 'N' denotes nervousness and 'C' denotes change. 6 Patients have rated change as the most important feature in identifying melanoma. 11 Our data show that change is correlated with concern: 825 of 1100 (75Á0%) of patients with concern also noted change.…”

Method of autofluorescence diagnostics of skin neoplasms in the near infrared region

“…This disease can occur in any humans independent of sex, age and other specific features. Although the skin neoplasms can be revealed even by a visual examination, their diagnostics is very complex, and only 40% of the disease cases can be diagnosed during the first visit to an experienced physician [1]. The "golden standard" of unambiguous identification of the neoplasm type in the oncology is the histologic examination that requires the sample biopsy.…”

In vivo hyperspectral imaging of skin malignant and benign tumors in visible spectrum

“…Thus, dermatoscopy opens up a new dimension on clinical morphology of pigmented skin lesions and enables well-trained physicians to improve their diagnostic accuracy up to 65% [8]. The use of dermatoscopy both improves clinical diagnostic accuracy and increases the ratio of skin cancers to all lesions biopsied or excised; moreover, this improvement is independent of the type of doctor using dermatoscopy [9].…”