Dermoscopy Improves Accuracy of Primary Care Physicians to Triage Lesions Suggestive of Skin Cancer

University of Florence, Florens, Tuscany, Italy
Journal of Clinical Oncology (Impact Factor: 18.43). 05/2006; 24(12):1877-82. DOI: 10.1200/JCO.2005.05.0864
Source: PubMed

ABSTRACT Primary care physicians (PCPs) constitute an appropriate target for new interventions and educational campaigns designed to increase skin cancer screening and prevention. The aim of this randomized study was to determine whether the adjunct of dermoscopy to the standard clinical examination improves the accuracy of PCPs to triage lesions suggestive of skin cancer.
PCPs in Barcelona, Spain, and Naples, Italy, were given a 1-day training course in skin cancer detection and dermoscopic evaluation, and were randomly assigned to the dermoscopy evaluation arm or naked-eye evaluation arm. During a 16-month period, 73 physicians evaluated 2,522 patients with skin lesions who attended their clinics and scored individual lesions as benign or suggestive of skin cancer. All patients were re-evaluated by expert dermatologists at clinics for pigmented lesions. Referral accuracy of both PCP groups was calculated by their scores, which were compared to those tabulated for dermatologists.
Referral sensitivity, specificity, and positive and negative predictive values were 54.1%, 71.3%, 11.3%, and 95.8%, respectively, in the naked-eye arm, and 79.2%, 71.8%, 16.1%, and 98.1%, respectively, in the dermoscopy arm. Significant differences were found in terms of sensitivity and negative predictive value (P = .002 and P = .004, respectively). Histopathologic examination of equivocal lesions revealed 23 malignant skin tumors missed by PCPs performing naked-eye observation and only six by PCPs using dermoscopy (P = .002).
The use of dermoscopy improves the ability of PCPs to triage lesions suggestive of skin cancer without increasing the number of unnecessary expert consultations.

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    • "In some developed countries it is the more frequent cancer in women younger than 29 years and men between 30 and 35 years. Melanoma is often lethal but can usually be cured if diagnosed early [2]. Therefore, early detection is important to increase the chance for successful treatment [3]. "
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    ABSTRACT: This paper proposes a new color correction pipeline to improve the dermoscopy image quality. Images acquired with different cameras or different dermoscopes often present problems of faithful color reproduction. The colors of these images are often far different the ones observed with the naked eye, and usually vary from one camera to another. Nowadays digital cameras perform "black-box" color corrections taking into account the color temperature of the imaged scene, which may result in some cases in unrealistic color rendering. For this reason, it is necessary to calibrate the imaging system (the camera and a specific dermoscope). The calibration process requires finding a relationship between a device-dependent color space and a standard color space depending only on the human eye. This relation is obtained acquiring known color patches of a color checker and relating them with the pixel values obtained by the camera. In our approach we model the color calibration problem using a new formulation that takes into account the spectral distribution of the dermoscope lighting system and conveys a solution for both RAW and JPEG images. When comparing images captured with different cameras, this new method improves the results between 0.1 and 0.9 ΔE with respect to previous approaches.
    Computerized medical imaging and graphics: the official journal of the Computerized Medical Imaging Society 04/2011; 35(7-8):646-52. DOI:10.1016/j.compmedimag.2011.03.006 · 1.22 Impact Factor
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    • "New approaches are required to improve GPs' assessment of pigmented skin lesions. Dermoscopy has been shown to improve the diagnostic accuracy for melanoma in the specialist setting [12] and in two randomised controlled trials in general practice [13,14]. However, dermoscopy is a relatively time-consuming technique to learn; in a recent trial of dermoscopy and digital monitoring Australian GPs required up to 30 hours of internet-based learning to acquire adequate skills and only 63% of those trained actually recruited patients into the trial. "
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    BMC Dermatology 09/2010; 10(9):9. DOI:10.1186/1471-5945-10-9
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    • "It has been recently claimed that dermoscopy is the conceptual and practical link between clinical dermatology (macrocosm) and dermatopathology (microcosm) [9], [14]. Like clinical dermatology, dermoscopy works in parallel to the skin surface; like histopathology, it allows to visualize structures which could not be discernible by the naked eye. "
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    PLoS ONE 06/2009; 4(4):e5375. DOI:10.1371/journal.pone.0005375 · 3.23 Impact Factor
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