title: Correlation of image analysis features and visual morphology in melanocytic skin tumours using in vivo confocal laser scanning microscopy.
abstract: OBJECTIVE
  In vivo confocal laser scanning microscopy (CLSM) represents a novel imaging tool that allows the non-invasive examination of skin cancer morphology at a quasi histological resolution without biopsy. Previous studies dealt with the search for diagnostic, but subjective visual criteria. In this study we examined the correlation between objectively reproducible image-analysis features und visual morphology in melanocytic skin tumours using CLSM.
  
  
  METHODS
  Eight hundred and fifty-seven CLSM tumour images including 408 benign nevi and 449 melanoma images were evaluated. Image analysis was based on features of the wavelet transform and classification tree analysis (CART) was used for classification purposes. In a second step, morphologic details of CLSM images, which have turned out to be of diagnostic significance by the classification algorithm were evaluated.
  
  
  RESULTS
  CART analysis of the whole set of CLSM images correctly classified 97.55% of all melanoma images and 96.32% of all nevi images. Seven classification tree nodes seemed to indicate benign nevi, whereas six nodes were suggestive for melanoma morphology. The visual examination of selected nodes demonstrated that monomorphic melanocytic cells and melanocytic cell nests are characteristic for benign nevi whereas polymorphic melanocytic cells, disarray of melanocytic architecture and poorly defined or absent keratinocyte cell borders are characteristic for melanoma.
  
  
  CONCLUSIONS
  Well-known, but subjective CLSM criteria could be objectively reproduced by image analysis features and classification tree analysis. Moreover, features not accessible to the human eye seem to contribute to classification success.
authors.affiliation: Department of Dermatology, Medical University Graz, Graz, Austria.
authors.forename: Andrea
authors.initials: A
authors.lastname: Lorber
authors.forename: Marco
authors.initials: M
authors.lastname: Wiltgen
authors.forename: Rainer
authors.initials: R
authors.lastname: Hofmann-Wellenhof
authors.forename: Silvia
authors.initials: S
authors.lastname: Koller
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Weger
authors.forename: Verena
authors.initials: V
authors.lastname: Ahlgrimm-Siess
authors.forename: Josef
authors.initials: J
authors.lastname: Smolle
authors.forename: Armin
authors.initials: A
authors.lastname: Gerger
mesh_terms: D046169:Dermoscopy / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008545:Melanoma / Q000473:pathology*; D018613:Microscopy, Confocal / Q000379:methods*; D009506:Nevus / Q000473:pathology*; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D012878:Skin Neoplasms / Q000473:pathology*; D013223:Statistics as Topic