A cancer-registry-assisted evaluation of the accuracy of digital epiluminescence microscopy associated with clinical examination of pigmented skin lesions.
BACKGROUND
The accuracy of digital epiluminescence microscopy (D-ELM) as an adjunct to clinical examination for the diagnosis of pigmented skin lesions (PSLs) has seldom been evaluated.


OBJECTIVE
To compare the accuracy of the combined clinical/D-ELM (C/D-ELM) examination with that of the clinical examination alone.


METHODS
A total of 3,372 PSLs from 1,556 consecutive patients referred to a skin cancer clinic underwent clinical examination and a combined C/D-ELM examination. The reference diagnosis was established using the histology report of known surgical excisions plus a cancer-registry-based follow-up (duration 18 months) of benign C/D-ELM diagnoses. The two diagnostic approaches were compared for sensitivity, predictive value and false-positive rate.


RESULTS
The series included 55 melanomas and 43 basal cell carcinomas. About 50% of malignant misdiagnosed cases were identified solely through the cancer registry. The C/D-ELM diagnosis showed a greater sensitivity for melanoma <0.76 mm thick (83 vs. 46% for clinical examination alone; ratio, 1.82) and basal cell carcinoma (79 vs. 49%; ratio, 1. 62), a greater predictive value for melanoma (81 vs. 53%; ratio, 1. 53) and a reduced total false-positive rate (0.3 vs. 0.9%; ratio, 0. 31).


CONCLUSIONS
D-ELM showed a potential to improve the clinical diagnosis of PSL.
Stanganelli
I
I
Skin Cancer Clinic, Center for Cancer Prevention, Department of Prevention, Ravenna Health Care District, Ravenna, Italy. igstanga@tin.it
Serafini
M
M
Bucch
L
L
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002280:Basal Cell Carcinoma / Q000473:pathology; D002648:Child; D003937:Diagnosis, Differential; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008163:Luminescent Measurements; D008297:Male; D008545:Melanoma / Q000473:pathology*; D008853:Microscopy / Q000379:methods*; D008875:Middle Aged; D009508:Nevus, Pigmented / Q000473:pathology; D012042:Registries; D012680:Sensitivity and Specificity; D012878:Skin Neoplasms / Q000473:pathology*