Dermoscopy compared with naked eye examination for the diagnosis of primary melanoma: a meta-analysis of studies performed in a clinical setting

Authors

  • M.E. Vestergaard,

    1. The Sydney Melanoma Diagnostic Centre and The Department of Dermatology, Sydney Cancer Centre, Royal Prince Alfred Hospital, Camperdown, NSW 2050, Australia
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  • P. Macaskill,

    1. The School of Public Health, University of Sydney, NSW 2006, Australia
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  • P.E. Holt,

    1. NSW Melanoma Network, 349 Pacific Hwy, North Sydney, NSW 2060, Australia
    2. Central Clinical School, The Faculty of Medicine, University of Sydney, NSW 2006, Australia
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  • S.W. Menzies

    1. The Sydney Melanoma Diagnostic Centre and The Department of Dermatology, Sydney Cancer Centre, Royal Prince Alfred Hospital, Camperdown, NSW 2050, Australia
    2. Central Clinical School, The Faculty of Medicine, University of Sydney, NSW 2006, Australia
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  • Conflicts of interest
    None declared.

S.W. Menzies.
E-mail: scott.menzies@email.cs.nsw.gov.au

Summary

Background  Dermoscopy is a noninvasive technique that enables the clinician to perform direct microscopic examination of diagnostic features, not seen by the naked eye, in pigmented skin lesions. Diagnostic accuracy of dermoscopy has previously been assessed in meta-analyses including studies performed in experimental and clinical settings.

Objectives  To assess the diagnostic accuracy of dermoscopy for the diagnosis of melanoma compared with naked eye examination by performing a meta-analysis exclusively on studies performed in a clinical setting.

Methods  We searched for publications from 1987 to January 2008 and found nine eligible studies. The selected studies compare diagnostic accuracy of dermoscopy with naked eye examination using a valid reference test on consecutive patients with a defined clinical presentation, performed in a clinical setting. Hierarchical summary receiver operator curve analysis was used to estimate the relative diagnostic accuracy for clinical examination with, and without, the use of dermoscopy.

Results  We found the relative diagnostic odds ratio for melanoma, for dermoscopy compared with naked eye examination, to be 15·6 [95% confidence interval (CI) 2·9–83·7, P = 0·016]; removal of two outlier studies changed this to 9·0 (95% CI 1·5–54·6, P = 0·03).

Conclusions  Dermoscopy is more accurate than naked eye examination for the diagnosis of cutaneous melanoma in suspicious skin lesions when performed in the clinical setting.

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