title: Dermoscopy compared with naked eye examination for the diagnosis of primary melanoma: a meta-analysis of studies performed in a clinical setting.
abstract: BACKGROUND
  Dermoscopy is a noninvasive technique that enables the clinician to perform direct microscopic examination of diagnostic features, not seen by the naked eye, in pigmented skin lesions. Diagnostic accuracy of dermoscopy has previously been assessed in meta-analyses including studies performed in experimental and clinical settings.
  
  
  OBJECTIVE
  To assess the diagnostic accuracy of dermoscopy for the diagnosis of melanoma compared with naked eye examination by performing a meta-analysis exclusively on studies performed in a clinical setting.
  
  
  METHODS
  We searched for publications from 1987 to January 2008 and found nine eligible studies. The selected studies compare diagnostic accuracy of dermoscopy with naked eye examination using a valid reference test on consecutive patients with a defined clinical presentation, performed in a clinical setting. Hierarchical summary receiver operator curve analysis was used to estimate the relative diagnostic accuracy for clinical examination with, and without, the use of dermoscopy.
  
  
  RESULTS
  We found the relative diagnostic odds ratio for melanoma, for dermoscopy compared with naked eye examination, to be 15.6 [95% confidence interval (CI) 2.9-83.7, P = 0.016]; removal of two outlier studies changed this to 9.0 (95% CI 1.5-54.6, P = 0.03).
  
  
  CONCLUSIONS
  Dermoscopy is more accurate than naked eye examination for the diagnosis of cutaneous melanoma in suspicious skin lesions when performed in the clinical setting.
authors.affiliation: The Sydney Melanoma Diagnostic Centre and The Department of Dermatology, Sydney Cancer Centre, Royal Prince Alfred Hospital, Camperdown, NSW 2050, Australia.
authors.forename: M E
authors.initials: ME
authors.lastname: Vestergaard
authors.forename: P
authors.initials: P
authors.lastname: Macaskill
authors.forename: P E
authors.initials: PE
authors.lastname: Holt
authors.forename: S W
authors.initials: SW
authors.lastname: Menzies
mesh_terms: D002986:Clinical Trials as Topic; D046169:Dermoscopy / Q000379:methods / Q000592:standards*; D006801:Humans; D008545:Melanoma / Q000175:diagnosis*; D009508:Nevus, Pigmented / Q000175:diagnosis; D010808:Physical Examination; D012372:ROC Curve; D012680:Sensitivity and Specificity; D012878:Skin Neoplasms / Q000175:diagnosis*