title: Influence of time on dermoscopic diagnosis and management.
abstract: OBJECTIVE
  Dermoscopy aids in clinical decision-making. However, time pressure is a common reason precluding its use. We evaluated the effect of time on lesion recognition and management decisions utilising clinical and dermoscopic images.
  
  
  METHODS
  In all, 100 dermoscopic images were presented to 15 dermatologists with experience in dermoscopy and seven non-experts (dermatology residents). Each lesion was displayed thrice in succession. The dermoscopic image was initially presented for 1 s (t1). The same dermoscopic image was shown again without time constraints (t2) and then a final time with additional images of the clinical context (t3). Participants provided a diagnosis, their level of confidence and biopsy predilection after evaluating each image.
  
  
  RESULTS
  For benign lesions, both groups rarely changed their diagnosis. However, an improvement in the number of correct benign diagnoses was observed when the lesion was shown in a clinical context. For malignant lesions, both groups improved when more time and clinical context was given; nevertheless, non-experts were more likely to change the diagnosis towards the correct one as more time was given and tended to perform more biopsies, in particular of benign lesions. Limitations were a small number of participants and an artificial study setting.
  
  
  CONCLUSIONS
  Dermoscopy uses analytical and non-analytical reasoning approaches. We suggest that non-analytical reasoning is employed when rapid clinical decisions need to be made, especially during the evaluation of benign lesions. We conclude that dermoscopy is relatively rapid and non-time-consuming technique that adds relevant information and guides clinicians towards appropriate management decisions.
authors.affiliation: Department of Dermatology, Memorial Sloan-Kettering Cancer Center, 160 E 53rd Street, New York, NY, USA.
authors.forename: Natalia
authors.initials: N
authors.lastname: Jaimes
authors.forename: Stephen W
authors.initials: SW
authors.lastname: Dusza
authors.forename: Elizabeth A
authors.initials: EA
authors.lastname: Quigley
authors.forename: Ralph P
authors.initials: RP
authors.lastname: Braun
authors.forename: Susana
authors.initials: S
authors.lastname: Puig
authors.forename: Josep
authors.initials: J
authors.lastname: Malvehy
authors.forename: Harald
authors.initials: H
authors.lastname: Kittler
authors.forename: Harold S
authors.initials: HS
authors.lastname: Rabinovitz
authors.forename: Margaret C
authors.initials: MC
authors.lastname: Oliviero
authors.forename: H Peter
authors.initials: HP
authors.lastname: Soyer
authors.forename: James M
authors.initials: JM
authors.lastname: Grichnik
authors.forename: Adam
authors.initials: A
authors.lastname: Korzenko
authors.forename: Horacio
authors.initials: H
authors.lastname: Cabo
authors.forename: Blanca
authors.initials: B
authors.lastname: Carlos-Ortega
authors.forename: Verena
authors.initials: V
authors.lastname: Ahlgrimm-Siess
authors.forename: Alfred W
authors.initials: AW
authors.lastname: Kopf
authors.forename: Ashfaq A
authors.initials: AA
authors.lastname: Marghoob
mesh_terms: D001706:Biopsy / Q000706:statistics & numerical data; D002983:Clinical Competence; D046169:Dermoscopy; D006801:Humans; D015588:Observer Variation; D012871:Skin Diseases / Q000473:pathology*; D013997:Time Factors