Mayer J; International Society of Technology Assessment in Health Care. Meeting.
Annu Meet Int Soc Technol Assess Health Care Int Soc Technol Assess Health Care Meet. 1997; 13: 126.
Darwin, NT, Australia.
BACKGROUND: Epiluminescence of skin surface microscopy with oil using the hand held dermatoscope or episcope is a technique that has been devloped for diagnosing pigmented skin lesions. Claims have been made that this technique of dermatoscopy improves the accuracy of diagnosing malignant melanoma. OBJECTIVE: The aim of this study was to review the literature in a systematic manner to see if the claims about improved diagnostic accuracy were justified. METHOD: Medline database 1983-1996 was searched in order to identify the number, quality and scope of primary research articles on accuracy of dermatoscopy over clinical diagnosis for melanoma. 196 articles were identified and reviewed for the following inclusion criteria: 1. An original study on accuracy of diagnosis of melanomal with dermatoscopy with a formal method and results sections. 2. Dermatoscopy diagnosis compared to gold standard of histopathology. 3. A spectrum of stages of melanomal and skin lesions commonly confused with melanoma. 4. Published in English. RESULTS: Six articles met the inclusion criteria. The designs of the studies are summarised and the sensitivity, specificity and likelihood ratio results are presented. Sensitivity was increased by 10-27% in the studies with the most clinically equivocal lesions. When sensitivity of clinical diagnosis was greater than 84%, dermatoscopy provided a very small increase in sensitivity. One study with dermatologists who had not training in dermatoscopy resulted in a significant decrease in sensitivity. The large range in sensitivity and specificity is most likely explained by the differences in the pigmented skin lesions within each study. CONCLUSIONS: Overall, evivdence suggests that improvement in diagnosis with dermatoscopy is dependent on explicit diagnostic criteria and training and experience in the technique. This systematic review demonstrated large variations in the methods, observers and in the types of pigmented skin lesions between the studies. This variation meant that meta-analysis (a statistical summary) was not possible. However, the systematic review is still able to provide a descriptive summary of the available data and recommendations can be made to improve the research design in future studies.
Publication Types:
Keywords:
- Dermoscopy
- Melanoma
- Microscopy
- Pigmentation
- Pigmentation Disorders
- Predictive Value of Tests
- Research Design
- Sensitivity and Specificity
- Skin Neoplasms
- United States
- diagnosis
- methods
- hsrmtgs
Other ID:
UI: 102233251
From Meeting Abstracts