Melanoma detection. A prospective study comparing diagnosis with the naked eye, dermatoscopy and telespectrophotometry.
BACKGROUND
Successful treatment of melanoma depends directly on early diagnosis. Such a diagnosis is based on clinical examination and dermatoscopy. Recently, automated instruments for melanoma detection are under development.


OBJECTIVE
To prospectively evaluate the diagnostic possibilities provided by clinical and dermatoscopic examinations and by a computerized telespectrophotometric system (TS).


METHODS
The study involves a consecutive series of 298 patients with 313 cutaneous pigmented lesions (66 melanomas and 247 non-melanoma lesions). Each lesion was subjected to the triple diagnostic evaluation, before surgery. Results were expressed in terms of sensitivity and specificity of each kind of evaluation.


RESULTS
Clinical evaluation had sensitivity and specificity values of 86 and 77%, respectively, whereas dermatoscopy gave corresponding values of 91 and 74%. TS assessment resulted in a sensitivity of 80% and a specificity of 49%. Differences between clinical and dermatoscopic diagnoses lacked statistical significance (p = 0.22), whereas there was a significant difference comparing both clinical and TS evaluations (p < 0.01) and dermatoscopic and TS evaluations (p < 0.01). Combining clinical and dermatoscopic evaluations, a sensitivity of 97% was achieved. Addition of TS has not changed this figure.


CONCLUSIONS
Results of this study confirm and stress the importance of dermatoscopy in the diagnosis of melanoma. Clinical evaluation coupled with dermatoscopy can be considered the cornerstone of such a diagnosis. Although TS is able to achieve interesting results, at present it cannot significantly compete with any of the other tested methods.
Bono
Aldo
A
Melanoma Unit, Istituto Nazionale per lo Studio e la Cura dei Tumori, Milan, Italy. fisicaint@tiscalinet.it
Bartoli
Cesare
C
Cascinelli
Natale
N
Lualdi
Manuela
M
Maurichi
Andrea
A
Moglia
Daniele
D
Tragni
Gabrina
G
Tomatis
Stefano
S
Marchesini
Renato
R
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001707:Biopsy, Needle; D002648:Child; D015331:Cohort Studies; D003880:Dermatology / Q000295:instrumentation*; D003936:Diagnosis, Computer-Assisted; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D007558:Italy; D008297:Male; D008545:Melanoma / Q000175:diagnosis / Q000473:pathology*; D008875:Middle Aged; D009508:Nevus, Pigmented / Q000175:diagnosis / Q000473:pathology*; D010808:Physical Examination / Q000379:methods; D011446:Prospective Studies; D012680:Sensitivity and Specificity; D012878:Skin Neoplasms / Q000175:diagnosis / Q000473:pathology*; D013053:Spectrophotometry / Q000379:methods