title: To excise or not: impact of MelaFind on German dermatologists' decisions to biopsy atypical lesions.
abstract: OBJECTIVE
  To determine the biopsy sensitivity to melanoma of dermatologists in Germany and the impact of MelaFind® on their decisions to biopsy melanomas.
  
  
  METHODS
  Randomized two-armed online reader study presenting case information, clinical/dermatoscopic images of pigmented skin lesions and MelaFind results (Arm 2).
  
  
  METHODS
  Each participant was asked to review 130 pigmented skin lesions. Biopsy decisions of dermatologists without MelaFind versus MelaFind and dermatologists without MelaFind versus dermatologists with MelaFind were compared.
  
  
  RESULTS
  Dermatologists without MelaFind had average sensitivity to melanoma of 69.5 % and average specificity of 55.9 %. MelaFind had greater sensitivity than dermatologists alone (96.9 % vs. 69.5 %, one-sided p < 0.00001) and lower specificity (9.2 % vs. 55.9 %, one-sided p < 0.00001). Dermatologists with MelaFind had higher sensitivity than those without MelaFind (78 % vs. 69.5 %, one-sided p < 0.00001) and a lower specificity (45.8 % vs. 55.9 %, one-sided p < 0.00001). The number of dermatologists detecting over 90 % of melanomas increased from 3 of 101 without MelaFind to 22 of 101 with MelaFind (p = 0.00006) while specificity remained relatively equivalent (23 % vs. 21 %, p = 0.99).
  
  
  CONCLUSIONS
  The MelaFind information, when incorporated into the final biopsy decision, can improve biopsy sensitivity with modest effect on biopsy specificity.
authors.affiliation: University Hospital Schleswig-Holstein (UKSH), Campus Kiel, Kiel, Germany.
authors.forename: Axel
authors.initials: A
authors.lastname: Hauschild
authors.forename: Suephy C
authors.initials: SC
authors.lastname: Chen
authors.forename: Michael
authors.initials: M
authors.lastname: Weichenthal
authors.forename: Andreas
authors.initials: A
authors.lastname: Blum
authors.forename: Hadley C
authors.initials: HC
authors.lastname: King
authors.forename: Jeff
authors.initials: J
authors.lastname: Goldsmith
authors.forename: Daniel
authors.initials: D
authors.lastname: Scharfstein
authors.forename: Dina
authors.initials: D
authors.lastname: Gutkowicz-Krusin
mesh_terms: D000328:Adult; D003657:Decision Making; D003880:Dermatology / Q000706:statistics & numerical data; D046169:Dermoscopy / Q000295:instrumentation* / Q000706:statistics & numerical data; D003936:Diagnosis, Computer-Assisted / Q000295:instrumentation* / Q000379:methods / Q000706:statistics & numerical data; D055088:Early Detection of Cancer / Q000295:instrumentation* / Q000706:statistics & numerical data; D004867:Equipment Design; D019544:Equipment Failure Analysis; D005260:Female; D005858:Germany / Q000453:epidemiology; D006801:Humans; D008297:Male; D008545:Melanoma / Q000453:epidemiology / Q000473:pathology* / Q000601:surgery*; D008875:Middle Aged; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D012878:Skin Neoplasms / Q000453:epidemiology / Q000473:pathology* / Q000601:surgery*; D011795:Surveys and Questionnaires