Accuracy of dermatoscopy for the diagnosis of nonpigmented cancers of the skin

Abstract

Background: Nonpigmented skin cancer is common, and diagnosis with the unaided eye is error prone.

Objective: To investigate whether dermatoscopy improves the diagnostic accuracy for nonpigmented (amelanotic) cutaneous neoplasms.

Methods: We collected a sample of 2072 benign and malignant neoplastic lesions and inflammatory conditions and presented close-up images taken with and without dermatoscopy to 95 examiners with different levels of experience.

Results: The area under the curve was significantly higher with than without dermatoscopy (0.68 vs 0.64, P < .001). Among 51 possible diagnoses, the correct diagnosis was selected in 33.1% of cases with and 26.4% of cases without dermatoscopy (P < .001). For experts, the frequencies of correct specific diagnoses of a malignant lesion improved from 40.2% without to 51.3% with dermatoscopy. For all malignant neoplasms combined, the frequencies of appropriate management strategies increased from 78.1% without to 82.5% with dermatoscopy.

Limitations: The study deviated from a real-life clinical setting and was potentially affected by verification and selection bias.

Conclusions: Dermatoscopy improves the diagnosis and management of nonpigmented skin cancer and should be used as an adjunct to examination with the unaided eye.

Keywords: dermatoscopy; dermoscopy; diagnosis; keratinocytic skin cancer; melanoma; nonpigmented skin cancer.