title: The performance of SolarScan: an automated dermoscopy image analysis instrument for the diagnosis of primary melanoma.
abstract: OBJECTIVE
  To describe the diagnostic performance of SolarScan (Polartechnics Ltd, Sydney, Australia), an automated instrument for the diagnosis of primary melanoma.
  
  
  METHODS
  Images from a data set of 2430 lesions (382 were melanomas; median Breslow thickness, 0.36 mm) were divided into a training set and an independent test set at a ratio of approximately 2:1. A diagnostic algorithm (absolute diagnosis of melanoma vs benign lesion and estimated probability of melanoma) was developed and its performance described on the test set. High-quality clinical and dermoscopy images with a detailed patient history for 78 lesions (13 of which were melanomas) from the test set were given to various clinicians to compare their diagnostic accuracy with that of SolarScan.
  
  
  METHODS
  Seven specialist referral centers and 2 general practice skin cancer clinics from 3 continents. Comparison between clinician diagnosis and SolarScan diagnosis was by 3 dermoscopy experts, 4 dermatologists, 3 trainee dermatologists, and 3 general practitioners.
  
  
  METHODS
  Images of the melanocytic lesions were obtained from patients who required either excision or digital monitoring to exclude malignancy.
  
  
  METHODS
  Sensitivity, specificity, the area under the receiver operator characteristic curve, median probability for the diagnosis of melanoma, a direct comparison of SolarScan with diagnoses performed by humans, and interinstrument and intrainstrument reproducibility.
  
  
  RESULTS
  The melanocytic-only diagnostic model was highly reproducible in the test set and gave a sensitivity of 91% (95% confidence interval [CI], 86%-96%) and specificity of 68% (95% CI, 64%-72%) for melanoma. SolarScan had comparable or superior sensitivity and specificity (85% vs 65%) compared with those of experts (90% vs 59%), dermatologists (81% vs 60%), trainees (85% vs 36%; P =.06), and general practitioners (62% vs 63%). The intraclass correlation coefficient of intrainstrument repeatability was 0.86 (95% CI, 0.83-0.88), indicating an excellent repeatability. There was no significant interinstrument variation (P = .80).
  
  
  CONCLUSIONS
  SolarScan is a robust diagnostic instrument for pigmented or partially pigmented melanocytic lesions of the skin. Preliminary data suggest that its performance is comparable or superior to that of a range of clinician groups. However, these findings should be confirmed in a formal clinical trial.
authors.affiliation: Sydney Melanoma Diagnostic Centre, Sydney Cancer Centre, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia. scott.menzies@email.cs.nsw.gov.au
authors.forename: Scott W
authors.initials: SW
authors.lastname: Menzies
authors.forename: Leanne
authors.initials: L
authors.lastname: Bischof
authors.forename: Hugues
authors.initials: H
authors.lastname: Talbot
authors.forename: Alex
authors.initials: A
authors.lastname: Gutenev
authors.forename: Michelle
authors.initials: M
authors.lastname: Avramidis
authors.forename: Livian
authors.initials: L
authors.lastname: Wong
authors.forename: Sing Kai
authors.initials: SK
authors.lastname: Lo
authors.forename: Geoffrey
authors.initials: G
authors.lastname: Mackellar
authors.forename: Victor
authors.initials: V
authors.lastname: Skladnev
authors.forename: William
authors.initials: W
authors.lastname: McCarthy
authors.forename: John
authors.initials: J
authors.lastname: Kelly
authors.forename: Brad
authors.initials: B
authors.lastname: Cranney
authors.forename: Peter
authors.initials: P
authors.lastname: Lye
authors.forename: Harold
authors.initials: H
authors.lastname: Rabinovitz
authors.forename: Margaret
authors.initials: M
authors.lastname: Oliviero
authors.forename: Andreas
authors.initials: A
authors.lastname: Blum
authors.forename: Alexandra
authors.initials: A
authors.lastname: Varol
authors.forename: Alexandra
authors.initials: A
authors.lastname: Virol
authors.forename: Brian
authors.initials: B
authors.lastname: De'Ambrosis
authors.forename: Roderick
authors.initials: R
authors.lastname: McCleod
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Koga
authors.forename: Caron
authors.initials: C
authors.lastname: Grin
authors.forename: Ralph
authors.initials: R
authors.lastname: Braun
authors.forename: Robert
authors.initials: R
authors.lastname: Johr
mesh_terms: D000465:Algorithms; D001315:Australia; D046169:Dermoscopy / Q000379:methods*; D005431:Florida; D005858:Germany; D006801:Humans; D007091:Image Processing, Computer-Assisted / Q000379:methods; D008499:Medical Records; D008545:Melanoma / Q000175:diagnosis* / Q000473:pathology; D009508:Nevus, Pigmented / Q000175:diagnosis* / Q000473:pathology; D011237:Predictive Value of Tests; D012372:ROC Curve; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D012878:Skin Neoplasms / Q000175:diagnosis* / Q000473:pathology