Dermoscopy of pigmented skin lesions: results of a consensus meeting via the Internet.
BACKGROUND
There is a need for better standardization of the dermoscopic terminology in assessing pigmented skin lesions.


OBJECTIVE
The virtual Consensus Net Meeting on Dermoscopy was organized to investigate reproducibility and validity of the various features and diagnostic algorithms.


METHODS
Dermoscopic images of 108 lesions were evaluated via the Internet by 40 experienced dermoscopists using a 2-step diagnostic procedure. The first-step algorithm distinguished melanocytic versus nonmelanocytic lesions. The second step in the diagnostic procedure used 4 algorithms (pattern analysis, ABCD rule, Menzies method, and 7-point checklist) to distinguish melanoma versus benign melanocytic lesions. kappa Values, log odds ratios, sensitivity, specificity, and positive likelihood ratios were estimated for all diagnostic algorithms and dermoscopic features.


RESULTS
Interobserver agreement was fair to good for all diagnostic methods, but it was poor for the majority of dermoscopic criteria. Intraobserver agreement was good to excellent for all algorithms and features considered. Pattern analysis allowed the best diagnostic performance (positive likelihood ratio: 5.1), whereas alternative algorithms revealed comparable sensitivity but less specificity. Interobserver agreement on management decisions made by dermoscopy was fairly good (mean kappa value: 0.53).


CONCLUSIONS
The virtual Consensus Net Meeting on Dermoscopy represents a valid tool for better standardization of the dermoscopic terminology and, moreover, opens up a new territory for diagnosing and managing pigmented skin lesions.
Department of Dermatology, Second University of Naples, Italy.
Giuseppe
G
Argenziano
H Peter
HP
Soyer
Sergio
S
Chimenti
Renato
R
Talamini
Rosamaria
R
Corona
Francesco
F
Sera
Michael
M
Binder
Lorenzo
L
Cerroni
Gaetano
G
De Rosa
Gerardo
G
Ferrara
Rainer
R
Hofmann-Wellenhof
Michael
M
Landthaler
Scott W
SW
Menzies
Hubert
H
Pehamberger
Domenico
D
Piccolo
Harold S
HS
Rabinovitz
Roman
R
Schiffner
Stefania
S
Staibano
Wilhelm
W
Stolz
Igor
I
Bartenjev
Andreas
A
Blum
Ralph
R
Braun
Horacio
H
Cabo
Paolo
P
Carli
Vincenzo
V
De Giorgi
Matthew G
MG
Fleming
James M
JM
Grichnik
Caron M
CM
Grin
Allan C
AC
Halpern
Robert
R
Johr
Brian
B
Katz
Robert O
RO
Kenet
Harald
H
Kittler
Jürgen
J
Kreusch
Josep
J
Malvehy
Giampiero
G
Mazzocchetti
Margaret
M
Oliviero
Fezal
F
Ozdemir
Ketty
K
Peris
Roberto
R
Perotti
Ana
A
Perusquia
Maria Antonietta
MA
Pizzichetta
Susana
S
Puig
Babar
B
Rao
Pietro
P
Rubegni
Toshiaki
T
Saida
Massimiliano
M
Scalvenzi
Stefania
S
Seidenari
Ignazio
I
Stanganelli
Masaru
M
Tanaka
Karin
K
Westerhoff
Ingrid H
IH
Wolf
Otto
O
Braun-Falco
Helmut
H
Kerl
Takeji
T
Nishikawa
Klaus
K
Wolff
Alfred W
AW
Kopf
D000465:Algorithms; D002280:Basal Cell Carcinoma / Q000175:diagnosis / Q000473:pathology; D003937:Diagnosis, Differential; D006801:Humans; D020407:Internet; D008545:Melanoma / Q000145:classification / Q000175:diagnosis* / Q000473:pathology*; D008853:Microscopy / Q000379:methods* / Q000592:standards; D010781:Photography; D017410:Practice Guidelines as Topic; D012016:Reference Values; D012680:Sensitivity and Specificity; D012871:Skin Diseases / Q000175:diagnosis / Q000473:pathology; D012878:Skin Neoplasms / Q000145:classification / Q000175:diagnosis* / Q000473:pathology*; D012880:Skin Pigmentation; D009626:Terminology as Topic