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2016 ; 152
(7
): 798-806
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Validity and Reliability of Dermoscopic Criteria Used to Differentiate Nevi From
Melanoma: A Web-Based International Dermoscopy Society Study
#MMPMID27074267
Carrera C
; Marchetti MA
; Dusza SW
; Argenziano G
; Braun RP
; Halpern AC
; Jaimes N
; Kittler HJ
; Malvehy J
; Menzies SW
; Pellacani G
; Puig S
; Rabinovitz HS
; Scope A
; Soyer HP
; Stolz W
; Hofmann-Wellenhof R
; Zalaudek I
; Marghoob AA
JAMA Dermatol
2016[Jul]; 152
(7
): 798-806
PMID27074267
show ga
IMPORTANCE: The comparative diagnostic performance of dermoscopic algorithms and
their individual criteria are not well studied. OBJECTIVES: To analyze the
discriminatory power and reliability of dermoscopic criteria used in melanoma
detection and compare the diagnostic accuracy of existing algorithms. DESIGN,
SETTING, AND PARTICIPANTS: This was a retrospective, observational study of 477
lesions (119 melanomas [24.9%] and 358 nevi [75.1%]), which were divided into 12
image sets that consisted of 39 or 40 images per set. A link on the International
Dermoscopy Society website from January 1, 2011, through December 31, 2011,
directed participants to the study website. Data analysis was performed from June
1, 2013, through May 31, 2015. Participants included physicians, residents, and
medical students, and there were no specialty-type or experience-level
restrictions. Participants were randomly assigned to evaluate 1 of the 12 image
sets. MAIN OUTCOMES AND MEASURES: Associations with melanoma and intraclass
correlation coefficients (ICCs) were evaluated for the presence of dermoscopic
criteria. Diagnostic accuracy measures were estimated for the following
algorithms: the ABCD rule, the Menzies method, the 7-point checklist, the 3-point
checklist, chaos and clues, and CASH (color, architecture, symmetry, and
homogeneity). RESULTS: A total of 240 participants registered, and 103 (42.9%)
evaluated all images. The 110 participants (45.8%) who evaluated fewer than 20
lesions were excluded, resulting in data from 130 participants (54.2%), 121
(93.1%) of whom were regular dermoscopy users. Criteria associated with melanoma
included marked architectural disorder (odds ratio [OR], 6.6; 95% CI, 5.6-7.8),
pattern asymmetry (OR, 4.9; 95% CI, 4.1-5.8), nonorganized pattern (OR, 3.3; 95%
CI, 2.9-3.7), border score?of 6 (OR, 3.3; 95% CI, 2.5-4.3), and contour asymmetry
(OR, 3.2; 95% CI, 2.7-3.7) (P?.001 for all). Most dermoscopic criteria had poor
to fair interobserver agreement. Criteria that reached moderate levels of
agreement included comma vessels (ICC, 0.44; 95% CI, 0.40-0.49), absence of
vessels (ICC, 0.46; 95% CI, 0.42-0.51), dark brown color (ICC, 0.40; 95% CI,
0.35-0.44), and architectural disorder (ICC, 0.43; 95% CI, 0.39-0.48). The
Menzies method had the highest sensitivity for melanoma diagnosis (95.1%) but the
lowest specificity (24.8%) compared with any other method (P?.001). The ABCD
rule had the highest specificity (59.4%). All methods had similar areas under the
receiver operating characteristic curves. CONCLUSIONS AND RELEVANCE: Important
dermoscopic criteria for melanoma recognition were revalidated by participants
with varied experience. Six algorithms tested had similar but modest levels of
diagnostic accuracy, and the interobserver agreement of most individual criteria
was poor.