title: Risks and benefits of sequential imaging of melanocytic skin lesions in patients with multiple atypical nevi.
abstract: OBJECTIVE
  To evaluate the utility of sequential imaging of melanocytic skin lesions.
  
  
  METHODS
  With the use of a computerized test environment, digital images of 80 melanocytic skin lesions (including 10 early melanomas) were presented to 24 dermatologists with different levels of experience in 3 sessions. The 3 sessions were designed to simulate the decision-making process (1) without the possibility of follow-up, (2) with the possibility of follow-up, and (3) after presentation of follow-up images.
  
  
  METHODS
  Diagnostic performance in terms of sensitivity, specificity, accuracy, treatment threshold, and utility.
  
  
  RESULTS
  The possibility of follow-up increased the treatment threshold in all groups of dermatologists compared with decision making without the possibility of follow-up. The increase of the treatment threshold was accompanied by a loss of sensitivity and a gain in specificity. The overall diagnostic accuracy remained unchanged. After presentation of follow-up images, the diagnostic accuracy improved significantly. The sensitivity improved for all readers, but the specificity improved only for the most experienced readers. The utility of sequential imaging depended on the compliance of patients with follow-up. Under the assumption that all patients are compliant with follow-up, the utility of sequential imaging was superior to decision making without follow-up over a broad range of benefit-risk ratios.
  
  
  CONCLUSIONS
  Sequential imaging of melanocytic skin lesions is a useful procedure for patients with multiple atypical nevi. Uncritical use of sequential imaging cannot be recommended, because the utility of this technique depends on the experience in the interpretation of follow-up images and on the patient's compliance with follow-up.
authors.affiliation: Division of General Dermatology, Department of Dermatology, University of Vienna Medical School, Austria. h.kittler@akh-wien.ac.at
authors.forename: H
authors.initials: H
authors.lastname: Kittler
authors.forename: M
authors.initials: M
authors.lastname: Binder
mesh_terms: D002983:Clinical Competence; D003880:Dermatology / Q000592:standards; D003937:Diagnosis, Differential; D003952:Diagnostic Imaging / Q000592:standards*; D006801:Humans; D007091:Image Processing, Computer-Assisted / Q000592:standards*; D008545:Melanoma / Q000473:pathology*; D009508:Nevus, Pigmented / Q000473:pathology*; D010349:Patient Compliance; D011237:Predictive Value of Tests; D012307:Risk Factors; D012680:Sensitivity and Specificity; D012878:Skin Neoplasms / Q000473:pathology*; D013997:Time Factors