title: Diagnosis of pigmented skin lesions by dermoscopy: web-based training improves diagnostic performance of non-experts.
abstract: BACKGROUND
  Dermoscopy has been shown to enhance the diagnosis of melanoma. However, use of dermoscopy requires training and expertise to be effective.
  
  
  OBJECTIVE
  To determine whether an Internet-based course is a suitable tool in teaching dermoscopy, and to evaluate the diagnostic value of pattern analysis and diagnostic algorithms in colleagues not yet familiar with this technique.
  
  
  METHODS
  Sixteen colleagues who were not experts in dermoscopy were asked to evaluate the dermoscopic images of 20 pigmented skin lesions using different diagnostic methods (i.e. pattern analysis, ABCD rule, seven-point checklist and Menzies' method), before and after an Internet-based training course on dermoscopy. Mean +/- SEM sensitivity, specificity and diagnostic accuracy, and kappa (kappa) intraobserver agreement were evaluated for each diagnostic method before and after training for the 16 participants. Differences between mean values were assessed by means of two-tailed Wilcoxon rank-sum tests.
  
  
  RESULTS
  There was a considerable improvement in the dermoscopic melanoma diagnosis after the Web-based training vs. before. Improvements in sensitivity and diagnostic accuracy were significant for the ABCD rule and Menzies' method. Improvements in sensitivity were also significant for pattern analysis, whereas the sensitivity values were high for the seven-point checklist in evaluations both before and after training. No significant difference was found for specificity before and after training for any method. There was a significant improvement in the kappa intraobserver agreement after training for pattern analysis and the ABCD rule. For the seven-point checklist and Menzies' method there was already good agreement before training, with no significant improvement after training.
  
  
  CONCLUSIONS
  We demonstrated that Web-based training is an effective tool for teaching dermoscopy.
authors.affiliation: Department of Dermatology, University of Rome Tor Vergata, P.le dell'Umanesimo 10, 00144 Rome, Italy.
authors.forename: G
authors.initials: G
authors.lastname: Pagnanelli
authors.forename: H P
authors.initials: HP
authors.lastname: Soyer
authors.forename: G
authors.initials: G
authors.lastname: Argenziano
authors.forename: R
authors.initials: R
authors.lastname: Talamini
authors.forename: R
authors.initials: R
authors.lastname: Barbati
authors.forename: L
authors.initials: L
authors.lastname: Bianchi
authors.forename: E
authors.initials: E
authors.lastname: Campione
authors.forename: I
authors.initials: I
authors.lastname: Carboni
authors.forename: A M
authors.initials: AM
authors.lastname: Carrozzo
authors.forename: M S
authors.initials: MS
authors.lastname: Chimenti
authors.forename: I
authors.initials: I
authors.lastname: de Simoni
authors.forename: V
authors.initials: V
authors.lastname: Falcomatà
authors.forename: I
authors.initials: I
authors.lastname: Filipe Neto
authors.forename: F
authors.initials: F
authors.lastname: Francesconi
authors.forename: A
authors.initials: A
authors.lastname: Ginebri
authors.forename: J
authors.initials: J
authors.lastname: Hagman
authors.forename: G C
authors.initials: GC
authors.lastname: Marulli
authors.forename: F
authors.initials: F
authors.lastname: Palamara
authors.forename: A P
authors.initials: AP
authors.lastname: Vidolin
authors.forename: P
authors.initials: P
authors.lastname: Piemonte
authors.forename: R
authors.initials: R
authors.lastname: Soda
authors.forename: S
authors.initials: S
authors.lastname: Chimenti
mesh_terms: D002983:Clinical Competence; D003194:Computer-Assisted Instruction / Q000379:methods; D003880:Dermatology / Q000193:education*; D003937:Diagnosis, Differential; D004502:Education, Medical, Continuing / Q000379:methods*; D006801:Humans; D020407:Internet; D008545:Melanoma / Q000175:diagnosis*; D009508:Nevus, Pigmented / Q000175:diagnosis; D015588:Observer Variation; D012680:Sensitivity and Specificity; D012878:Skin Neoplasms / Q000175:diagnosis*