title: Availability of digital dermoscopy in daily practice dramatically reduces the number of excised melanocytic lesions: results from an observational study.
abstract: BACKGROUND
  Digital dermoscopy has been shown to permit an earlier detection of melanoma. However, few studies have investigated its added value in reducing unnecessary excisions in everyday clinical practice.
  
  
  OBJECTIVE
  To compare, in daily practice, the efficiency of three dermoscopy methods: dermoscopy alone with little training, dermoscopy alone with adequate training and dermoscopy with adequate training and access to digital dermoscopy, and to confirm the safety of this latter approach.
  
  
  METHODS
  Thirty-six dermatologists working without digital dermoscopy were divided into two groups according to their training in dermoscopy. The third group constituted of two dermatologists working in a pigmented lesion clinic with access to the digital dermoscopy technique and eight additional dermatologists working in the same dermatology department. These 46 dermatologists included all presumed melanocytic lesions excised over a period of 1 year. The primary endpoint was the melanoma/nonmelanoma ratio (M/NM-R); secondary endpoints were the ratio of 'problem' naevi to common naevi (PN/CN-R), specificity and sensitivity for the diagnosis of melanoma, in situ/invasive melanoma ratio, and the mean Breslow thickness.
  
  
  RESULTS
  In total, 1865 excised lesions, including 231 melanomas, were included. In the digital dermoscopy availability group (DD-G) the M/NM-R was significantly better (1/2.43), as was the PN/CN-R (1/1.48) (P < 0.001 in both cases). The specificity was significantly higher in the DD-G and significantly higher for trained examiners as compared with examiners with little training. More that one-third of all melanomas discovered by digital dermoscopy were in situ, and the mean Breslow thickness was 0.32 mm for the invasive ones.
  
  
  CONCLUSIONS
  The reduction of unnecessary excisions when using digital dermoscopy compared with dermoscopy alone in our study suggests that access to digital dermoscopy offers a better management of pigmented lesions in daily practice. The high number of early lesions diagnosed by this technique confirms that its use is safe.
authors.affiliation: Department of Dermatology, Centre du Cancer, Cliniques Universitaires St Luc, Université Catholique de Louvain, avenue Hippocrate 10, 1200 Brussels, Belgium. isabelle.tromme@uclouvain.be
authors.forename: I
authors.initials: I
authors.lastname: Tromme
authors.forename: L
authors.initials: L
authors.lastname: Sacré
authors.forename: F
authors.initials: F
authors.lastname: Hammouch
authors.forename: C
authors.initials: C
authors.lastname: Legrand
authors.forename: L
authors.initials: L
authors.lastname: Marot
authors.forename: P
authors.initials: P
authors.lastname: Vereecken
authors.forename: I
authors.initials: I
authors.lastname: Theate
authors.forename: P
authors.initials: P
authors.lastname: van Eeckhout
authors.forename: P
authors.initials: P
authors.lastname: Richez
authors.forename: J F
authors.initials: JF
authors.lastname: Baurain
authors.forename: L
authors.initials: L
authors.lastname: Thomas
authors.forename: N
authors.initials: N
authors.lastname: Speybroeck
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D046169:Dermoscopy / Q000379:methods* / Q000592:standards; D055088:Early Detection of Cancer / Q000379:methods; D004502:Education, Medical, Continuing; D005260:Female; D006801:Humans; D007090:Image Interpretation, Computer-Assisted / Q000379:methods / Q000592:standards; D008297:Male; D008544:Melanocytes; D008545:Melanoma / Q000175:diagnosis* / Q000601:surgery; D008875:Middle Aged; D009508:Nevus, Pigmented / Q000175:diagnosis* / Q000601:surgery; D012307:Risk Factors; D012680:Sensitivity and Specificity; D012878:Skin Neoplasms / Q000175:diagnosis* / Q000601:surgery; D055815:Young Adult