Fidelidad en el Dx de Melanoma

Journal Scan / Research · May 14, 2020

The Use of Noninvasive Imaging Techniques in the Diagnosis of Melanoma

Journal of the American Academy of Dermatology

TAKE-HOME MESSAGE

• In this non–industry-sponsored, prospective study, the diagnostic concordance of the identification of melanoma using clinical/dermatoscopic examination, teledermoscopy, and four noninvasive imaging systems were compared. A total of 209 lesions from 184 patients deemed to be clinically challenging were analyzed by each system and triaged to be excised, not excised, or watched. All lesions were excised regardless of clinical diagnosis, and the histopathologic diagnosis was considered to be the diagnostic gold standard. Of the total lesions, 59 had a histopathologic diagnosis of melanoma or melanoma in situ. Local dermatologists had a 96.6% sensitivity and 32.2% specificity. The teledermoscopist had an 84.5% sensitivity and 82.6% specificity. Of the noninvasive imaging systems, FotoFinder® Moleanalyzer Pro had the highest sensitivity and specificity (88.1% and 78.8%) compared with Melafind® (82.5% and 52.4%), FotoFinder® Tuebinger Mole Analyzer (83.1% and 75.2%), and Verisante Aura™ (21.4% and 86.2%). The FotoFinder® Moleanalyzer Pro correctly diagnosed as melanoma the two lesions missed by the local dermatologists.

• This independent prospective study of melanoma/melanoma in situ diagnostic concordance suggests that some noninvasive melanoma imaging devices have a high sensitivity in detecting melanoma. However, with low specificity and low diagnostic accuracy, they do not replace a clinician's experience in choosing which lesions to excise. This is particularly true for lesions on hair-bearing areas or special sites, as well as in patients with skin types higher than Fitzpatrick III.

– Margaret Hammond, MD

Abstract 

BACKGROUND

Early detection of melanoma is crucial to improving the detection of thin curable melanomas. Non-invasive, computer-assisted methods have been developed to use at the bedside to aid in diagnoses but have not been compared directly in a clinical setting.

OBJECTIVE

We conducted a prospective diagnostic accuracy study comparing a dermatologist's clinical examination at the bedside, teledermatology, and non-invasive imaging techniques (FotoFinder®, Melafind®, Verisante AuraTM).

METHODS

184 patients were recruited prospectively from an outpatient dermatology clinic, with lesions imaged, assessed and excised. Skin specimens were assessed by 2 blinded pathologists, providing the gold standard comparison.

RESULTS

59 lesions from 56 patients had a histopathological diagnosis of melanoma, while 150 lesions from 128 patients were diagnosed as benign. Sensitivities and specificities were, respectively: MelaFind® (82.5%, 52.4%), Verisante AuraTM (21.4%, 86.2%), FotoFinder® Moleanalyzer Pro (88.1%, 78.8%). The sensitivity and specificity of the teledermoscopist (84.5%, 82.6%) and local dermatologist (96.6%, 32.2%) were also compared.

LIMITATIONS

There are inherent limitations in using pathology as the gold standard to compare sensitivities and specificities.

CONCLUSION

This study demonstrates that the highest sensitivity and specificity of the instruments was established with the FotoFinder® Moleanalyzer Pro, which could be a valuable tool to assist with, but not replace clinical decision making.

Journal of the American Academy of Dermatology

The Use of Non-Invasive Imaging Techniques in the Diagnosis of Melanoma: A Prospective Diagnostic Accuracy Study

J Am Acad Dermatol 2020 Apr 11;[EPub Ahead of Print], AN MacLellan, EL Price, P Publicover-Brouwer, K Matheson, TY Ly, S Pasternak, NM Walsh, CJ Gallant, A Oakley, PR Hull, RG Langley 

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Benjamin Hidalgo-Matlock
Skin Care Physicians of Costa Rica

Clinica Victoria en San Pedro: 4000-1054
Momentum Escazu: 2101-9574

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