title: Baseline factors influencing decisions on digital follow-up of melanocytic lesions in daily practice: an Italian multicenter survey.
abstract: BACKGROUND
  Guidelines for optimized use of digital follow-up of melanocytic lesions are not yet available, and little is known about inclusion criteria adopted in clinical practice.
  
  
  OBJECTIVE
  Our purpose was to describe the frequency of digital follow-up adoption in melanoma screening, the characteristics of patients and lesions selected, and the predictors of duration of the intervals of digital follow-up.
  
  
  METHODS
  Baseline characteristics of patients and lesions selected for digital follow-up in 12 Italian pigmented lesion clinics were examined. Predictors of a short follow-up interval (<or=3 months) compared with a 6-month interval were investigated by means of logistic regression analysis.
  
  
  RESULTS
  Out of 2116 subjects consecutively examined, 409 were submitted to digital follow-up (19.3%), with 1.6 mean lesions found per patient (range, 1-9; median, 1). According to an a posteriori analysis, 15.2% of the lesions were diagnostically equivocal and 7.8% of lesions had a total dermoscopy score (TDS) suggestive of malignancy. However, large differences in the TDS were found among the participating centers. Determinants of a short follow-up interval, adopted in 40.8% of patients, were the personal history of melanoma (odds ratio [OR] 2.56, 95% confidence interval [CI] 1.09-5.99) and the presence of atypical nevi (at least one atypical nevus (OR 4.54, 95% CI 2.45-8.42). Unexpectedly, the dermoscopic atypia of the lesion (TDS >4.75) was associated only with a marginal effect on the scheduled duration of follow-up interval (OR 1.34, 95% CI 0.97-1.86). These findings were confirmed by a multivariate analysis.
  
  
  CONCLUSIONS
  The adoption of different digital dermoscopy systems in the participating centers may have limited the reliability of the TDS assigned by a central group to dermoscopy images.
  
  
  CONCLUSIONS
  Practicing dermatologists who use digital epiluminescence microscopy in screening for melanoma decided to submit at least one melanocytic lesion to digital follow-up for approximately 1 patient for every 5 examined. This implies costs and time spent that need to be evaluated together with the benefits of this procedure from a large-scale perspective. The lack of well-defined guidelines for inclusion and exclusion criteria may hamper optimized use of digital follow-up in daily practice.
authors.affiliation: Department of Dermatology, University of Florence, Italy. paolo.carli@unifi.it
authors.forename: Paolo
authors.initials: P
authors.lastname: Carli
authors.forename: Giovanni
authors.initials: G
authors.lastname: Ghigliotti
authors.forename: Matteo
authors.initials: M
authors.lastname: Gnone
authors.forename: Alessandra
authors.initials: A
authors.lastname: Chiarugi
authors.forename: Emanuele
authors.initials: E
authors.lastname: Crocetti
authors.forename: Stefano
authors.initials: S
authors.lastname: Astorino
authors.forename: Ugo A
authors.initials: UA
authors.lastname: Berti
authors.forename: Paolo
authors.initials: P
authors.lastname: Broganelli
authors.forename: Antonio
authors.initials: A
authors.lastname: Carcaterra
authors.forename: Maria Teresa
authors.initials: MT
authors.lastname: Corradin
authors.forename: Giovanni
authors.initials: G
authors.lastname: Pellacani
authors.forename: Domenico
authors.initials: D
authors.lastname: Piccolo
authors.forename: Massimiliano
authors.initials: M
authors.lastname: Risulo
authors.forename: Ignazio
authors.initials: I
authors.lastname: Stanganelli
authors.forename: Vincenzo
authors.initials: V
authors.lastname: De Giorgi
mesh_terms: D000328:Adult; D003880:Dermatology / Q000639:trends; D005260:Female; D005500:Follow-Up Studies; D019538:Health Care Surveys; D006801:Humans; D007091:Image Processing, Computer-Assisted; D007558:Italy; D008297:Male; D008403:Mass Screening / Q000379:methods*; D008545:Melanoma / Q000175:diagnosis*; D016017:Odds Ratio; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians'; D012044:Regression Analysis; D015203:Reproducibility of Results; D012815:Signal Processing, Computer-Assisted; D012878:Skin Neoplasms / Q000175:diagnosis*; D013997:Time Factors