Impact of Dermoscopy on the Management of High-risk Patients From Melanoma Families: A Prospective Study

Abstract

Few studies have investigated the impact of dermoscopy on the management of relatives from melanoma families. The objective of this study was to assess the impact of dermoscopy on clinical diagnosis and management decisions in high-risk familial melanoma patients. In a prospective study 132 consecutive patients were recruited from the pigmented lesions clinic of a tertiary reference centre for familial melanoma. Dermatologists expert in dermoscopy identified 49 suspicious pigmented lesions and recorded pre- and post-dermoscopy diagnoses and management decisions. Dermoscopy was performed in 37% of the patients. Two melanomas were identified. Dermoscopy did not influence sensitivity (1.0), but resulted in 42% fewer excisions, increasing specificity from 0.53 to 0.74 (p = 0.031). Dermoscopy resulted in a large reduction in the number of unnecessary excisions. These results suggest that the main effect of dermoscopy in clinical practice for this high risk population is a significant increase in specificity, rather than sensitivity.

Impact ofin vivoreflectance confocal microscopy on the number needed to treat melanoma in doubtful lesions

“…The hypothetical NNT we have calculated for dermoscopy (3Á73) is in line with those of previous publications evaluating NNT for dermoscopy and digital dermoscopy. [12][13][14][15][16][17][18][19][20] Although several studies on the diagnostic accuracy of RCM have been published, not many evaluated the impact of RCM in a clinical setting. Only two studies compared the performance of RCM with dermoscopy, 23,29 and only the latter assessed the additive value of RCM in the management of melanocytic skin lesions.…”

“…11 The addition of dermoscopy to melanoma screening has been associated with a reduction in the false positive detection rate and a subsequent decrease of unnecessary excisions, showing a clinically relevant effect in terms of lesion management. [12][13][14][15][16][17][18][19][20] The reported NNT among nondermoscopy users ranged from about 10 to 15, 14,19 and dramatically improves to at least 4 14,19 and as low as 2Á4 for properly trained dermatologists with access to digital dermoscopy. 20 In vivo reflectance-mode confocal microscopy (RCM) is a noninvasive technique that allows examination of the epidermis and papillary dermis at cellular resolution.…”

Dermatoscopy for Melanoma and Pigmented Lesions

“…Thus, even in high-risk groups, dermatoscopy resulted in a significant reduction in the number of unnecessary excisions. 35 Patients with multiple equivocal nevi also present a challenge to dermatologists, because the unnecessary excision of multiple lesions is undesired. In a study of patients with multiple irregular nevi, dermatoscopists evaluated the lesions based only on morphologic features and then evaluated the lesion relative to other nevi from the same patient.…”

“…50 In a series of incipient or early featureless melanomas, more than half of melanomas and nevi (61.8%) showed no specific dermatoscopic features for melanoma after 1.5 to 4.5 months. After 4.5 to 8 months, 45% showed no specific dermatoscopic features, and after 8 months, 35.1% still showed no specific features. With longer follow-up, the changes that occurred were spreading and enlarging of the lesion asymmetrically, with concurrent architectural and color changes.…”

Use of and intentions to use dermoscopy among physicians in the United States

“…In a 2008 meta-analysis, the odds of melanoma detection by dermoscopy was 15.6 times higher than by naked-eye examination (CI = 2.9–83.7, p = .016), and the sensitivity rate was 90% compared to 71% for naked-eye examination with no significant changes in specificity [10]. In a more recent study, dermoscopy resulted in 42% fewer excisions compared to naked-eye examination and had a 21% increase in specificity [13]. …”