Background: Dermoscopy used by experts has been demonstrated to improve the diagnostic accuracy for melanoma. However, little is known about the diagnostic validity of dermoscopy when used by nonexperts. Objective: To evaluate the diagnostic performance of nonexperts using a new 3-point checklist based on a simplified dermoscopic pattern analysis. Methods: Clinical and dermoscopic images of 231 clinically equivocal and histopathologically proven pigmented skin lesions were examined by 6 nonexperts and 1 expert in dermoscopy. For each lesion the nonexperts assessed 3 dermoscopic criteria (asymmetry, atypical network and blue-white structures) constituting the 3-point method. In addition, all examiners made an overall diagnosis by using standard pattern analysis of dermoscopy. Results: Asymmetry, atypical network and blue-white structures were shown to be reproducible dermoscopic criteria, with a kappa value ranging from 0.52 to 0.55. When making the overall diagnosis, the expert had 89.6% sensitivity for malignant lesions (tested on 68 melanomas and 9 pigmented basal cell carcinomas), compared to 69.7% sensitivity achieved by the nonexperts. Remarkably, the sensitivity of the nonexperts using the 3-point checklist reached 96.3%. The specificity of the expert using overall diagnosis was 94.2% compared to 82.8 and 32.8% achieved by the nonexperts using overall diagnosis and 3-point checklist, respectively. Conclusion: The 3-point checklist is a valid and reproducible dermoscopic algorithm with high sensitivity for the diagnosis of melanoma in the hands of non-experts. Thus it may be applied as a screening procedure for the early detection of melanoma.

1.
Bafounta ML, Beauchet A, Aegerter P, Saiag P: Is dermoscopy (epiluminescence microscopy) useful for the diagnosis of melanoma? Results of a meta-analysis using techniques adapted to the evaluation of diagnostic tests. Arch Dermatol 2001;137:1343–1350.
2.
Kittler H, Pehamberger H, Wolff K, Binder M: Diagnostic accuracy of dermoscopy. Lancet Oncol 2002;3:159–165.
3.
Binder M, Schwarz M, Winkler A, et al: Epiluminescence microscopy: A useful tool for the diagnosis of pigmented skin lesions for formally trained dermatologists. Arch Dermatol 1995;131:286–291.
4.
Kenet RO, Fitzpatrick TB: Reducing mortality and morbidity of cutaneous melanoma: A six year plan. B. Identifying high and low risk pigmented lesions using epiluminescence microscopy. J Dermatol 1994;21:881–884.
5.
Stolz W, Riemann A, Cognetta AB, et al: ABCD rule of dermatoscopy: A new practical method for early recognition of malignant melanoma. Eur J Dermatol 1994;4:521–527.
6.
Menzies SW, Ingvar C, Crotty KA, McCarthy WH: Frequency and morphologic characteristics of invasive melanomas lacking specific surface microscopic features. Arch Dermatol 1996;132:1178–1182.
7.
Argenziano G, Fabbrocini G, Carli P, De Giorgi V, Sammarco E, Delfino M: Epiluminescence microscopy for the diagnosis of doubtful melanocytic skin lesions. Comparison of the ABCD rule of dermatoscopy and a new 7-point checklist based on pattern analysis. Arch Dermatol 1998;134:1563–1570.
8.
Dal Pozzo V, Benelli C, Roscetti E: The seven features for melanoma: A new dermoscopic algorithm for the diagnosis of malignant melanoma. Eur J Dermatol 1999;9:303–308.
9.
Soyer HP, Argenziano G, Chimenti S, Ruocco V: Dermoscopy of pigmented skin lesions. Eur J Dermatol 2001;11:270–277.
10.
Kittler H, Pehamberger H, Wolff K, Binder M: Follow-up of melanocytic skin lesions with digital epiluminescence microscopy: Patterns of modifications observed in early melanoma, atypical nevi, and common nevi. J Am Acad Dermatol 2000;43:467–476.
11.
Argenziano G, Soyer HP, Chimenti S, et al: Dermoscopy of pigmented skin lesions: Results of a consensus meeting via the Internet. J Am Acad Dermatol 2003;48:679–693.
12.
Fleiss JL: Measuring nominal scale agreement among many raters. Psychol Bull 1971;76:378–382.
13.
Fleiss JL: Statistical Methods for Rate and Proportions. New York, Wiley & Sons, 1981, pp 212–236.
14.
Fleiss JL, Nee JCM, Landis JR: The large sample variance of kappa in the case of different sets of raters. Psychol Bull 1979;86:974–977.
15.
Ronco G, Biggeri A: Estimating sensitivity and specificity when repeated tests are performed on the same subject. J Epidemiol Biostat 1999;4:329–336.
16.
Leisenring W, Pepe MS, Longton G: A marginal regression modelling framework for evaluating medical diagnostic tests. Stat Med 1997;16:1263–1281.
17.
Koh HK, Miller DR, Geller AC, et al: Who discovers melanoma? J Am Acad Dermatol 1992;26:914–919.
18.
Fiedman RJ, Rigel DS, Kopf AW: Early detection of malignant melanoma: The role of physician examination and self-examination of the skin. CA Cancer J Clin 1985;35:130–151.
19.
Guibert P, Mollat F, Ligen M, Dreno B: Melanoma screening: Report of a survey in occupational medicine. Arch Dermatol 2000;136:199–202.
20.
Grin CM, Kopf AW, Welkovich B, et al: Accuracy in the clincial diagnosis of malignant melanoma. Arch Dermatol 1990;126:763–766.
21.
Wolf IH, Smolle J, Soyer HP, Kerl H: Sensitivity in the clinical diagnosis of malignant melanoma. Melanoma Res 1998;8:425–429.
22.
Steiner A, Pehamberger H, Wolff K: In vivo epiluminescence microscopy of pigmented skin lesions. II. Diagnosis of small pigmented skin lesions and early detection of malignant melanoma. J Am Acad Dermatol 1987;17:584–591.
23.
Kenet RO, Kang S, Kenet BJ, et al: Clinical diagnosis of pigmented lesions using digital epiluminescence microscopy: Grading protocol and atlas. Arch Dermatol 1993;129:157–174.
24.
Soyer HP, Smolle J, Leitinger G, et al: Diagnostic reliability of dermoscopic criteria for detecting malignant melanoma. Dermatology 1995;190:25–30.
25.
Menzies SW, Ingvar C, McCarthy WH: A sensitivity and specificity analysis of the surface microscopy features of invasive melanoma. Melanoma Res 1996;6:55–62.
26.
Westerhoff K, McCarthy WH, Menzies SW: Increase in the sensitivity for melanoma diagnosis by primary care physicians using skin surface microscopy. Br J Dermatol 2000;143:1016–1020.
27.
Kittler H, Pehamberger H, Wolff K, Binder M: Follow-up of melanocytic skin lesions with digital epiluminescence microscopy: Patterns of modifications observed in early melanoma, atypical nevi, and common nevi. J Am Acad Dermatol 2000;43:467–476.
28.
Argenziano G, Soyer HP: Dermoscopy of pigmented skin lesions – A valuable tool for early diagnosis of melanoma. Lancet Oncol 2001;2:443–449.
29.
Soyer HP, Argenziano G, Talamini R, Cimenti S: Is dermoscopy useful for the diagnosis of melanoma? Arch Dermatol 2001;137:1361–1363.
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.