Metodo inverso para doagnostico de LM

The Dermatoscopic Inverse Approach for Lentigo Maligna Diagnosis

Journal of the American Academy of Dermatology

TAKE-HOME MESSAGE

• The "inverse approach" is a dermatoscopic method for the diagnosis of lentigo maligna (LM), in which the absence of prevalent non-melanoma patterns raises the concern for LM. Combining this approach with classic pattern analysis may improve early diagnosis of LM.

• Using a dataset of facial pigmented macules, attendees at a dermatoscopy master class classified by dermatoscopic skill level were taught the "inverse approach" to recognize LM. Prior to using this method, average sensitivity for LM was 51.5%, which increased to 56.7% with classic pattern analysis teaching. After being taught the inverse method, sensitivity for LM increased to 83.6%.

– Margaret Hammond, MD

Abstract

BACKGROUND

A recently introduced dermatoscopic method for diagnosis of early lentigo maligna (LM) is based on the absence of prevalent patterns of pigmented actinic keratosis (PAK) and solar lentigo/flat seborrheic keratosis (SL/SK). We term this the "inverse approach" OBJECTIVE: To determine whether training on the inverse approach increases the diagnostic accuracy of readers as compared to classic pattern analysis.

METHODS

We used clinical and dermatoscopic images of histopathologically diagnosed LMs, PAKs and SLs/SKs. Participants of a dermatoscopy masterclass classified the lesions at baseline, after training on pattern analysis and the inverse approach. We compared their diagnostic performance among the 3 time points and to that of a trained convolutional neural network (CNN).

RESULTS

The mean sensitivity for LM without training was 51.5%, after training on pattern analysis increased to 56.7% and after learning the inverse approach to 83.6%. The mean proportion of correct answers at the 3 time points was 62.1%, 65.5% and 78.5%. The percentage of readers outperforming the CNN was 6.4%, 15.4% and 53.9%, respectively.

LIMITATIONS

The experimental setting and the inclusion of histopathologically diagnosed lesions only.

CONCLUSIONS

The inverse approach, added to the classic pattern analysis, significantly improves the sensitivity of human readers for early LM diagnosis.

Journal of the American Academy of Dermatology

The Dermatoscopic Inverse Approach Significantly Improves the Accuracy of Human Readers for Lentigo Maligna Diagnosis

J Am Acad Dermatol 2020 Jun 24;[EPub Ahead of Print], A Lallas, K Lallas, P Tschandl, H Kittler, Z Apalla, C Longo, G Argenziano 

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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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