title: Accuracy of a smartphone application using fractal image analysis of pigmented moles compared to clinical diagnosis and histological result.
abstract: BACKGROUND
  Lately, various smartphone applications have been introduced as diagnostic self-monitoring tools in the evaluation of pigmented moles, but most of these techniques have not been evaluated systematically.
  
  
  OBJECTIVE
  The purpose of this study was to evaluate prospectively the sensitivity and specificity of a recently developed smartphone application using fractal image analysis for the risk evaluation algorithm in the diagnosis of malignant melanoma compared to clinical diagnosis and histopathological result.
  
  
  METHODS
  Consecutive patients with melanocytic lesions were recruited and clinical and dermoscopical diagnosis was documented by two dermatologists independently. Imaging and analysis with the smartphone application was performed prior to excision of lesions. The findings were compared to the histological results as gold standard.
  
  
  RESULTS
  Of 195 included lesions histopathological analysis revealed 40 melanomas, 42 dysplastic nevi and 113 benign nevi. The sensitivity of the diagnosis melanoma by fractal image analysis using smartphone images was 73%, the specificity was 83% compared to a sensitivity of 88% and specificity of 97% regarding the clinical diagnosis by the dermatologists.
  
  
  CONCLUSIONS
  The smartphone application using fractal analysis might be a promising tool in the pre-evaluation of pigmented moles by laypersons, while it is to date inferior to the diagnostic evaluation by a dermatologist.
authors.affiliation: Department of Dermatology and Allergology, University Hospital of Munich, Munich, Germany.
authors.forename: T
authors.initials: T
authors.lastname: Maier
authors.forename: D
authors.initials: D
authors.lastname: Kulichova
authors.forename: K
authors.initials: K
authors.lastname: Schotten
authors.forename: R
authors.initials: R
authors.lastname: Astrid
authors.forename: T
authors.initials: T
authors.lastname: Ruzicka
authors.forename: C
authors.initials: C
authors.lastname: Berking
authors.forename: A
authors.initials: A
authors.lastname: Udrea
mesh_terms: D000465:Algorithms; D046169:Dermoscopy; D017709:Fractals; D006801:Humans; D007091:Image Processing, Computer-Assisted; D008545:Melanoma / Q000473:pathology* / Q000601:surgery; D063731:Mobile Applications; D009508:Nevus, Pigmented / Q000473:pathology* / Q000601:surgery; D011446:Prospective Studies; D018570:Risk Assessment / Q000379:methods; D012680:Sensitivity and Specificity; D012878:Skin Neoplasms / Q000473:pathology* / Q000601:surgery; D000068997:Smartphone