title: Selective use of sequential digital dermoscopy imaging allows a cost reduction in the melanoma detection process: a belgian study of patients with a single or a small number of atypical nevi.
abstract: BACKGROUND
  Dermoscopy is a technique which improves melanoma detection. Optical dermoscopy uses a handheld optical device to observe the skin lesions without recording the images. Sequential digital dermoscopy imaging (SDDI) allows storage of the pictures and their comparison over time. Few studies have compared optical dermoscopy and SDDI from an economic perspective.
  
  
  OBJECTIVE
  The present observational study focused on patients with one-to-three atypical melanocytic lesions, i.e. lesions considered as suspicious by optical dermoscopy. It aimed to calculate the "extra-costs" related to the process of melanoma detection. These extra-costs were defined as the costs of excision and pathology of benign lesions and/or the costs of follow-up by SDDI. The objective was to compare these extra-costs when using optical dermoscopy exclusively versus optical dermoscopy with selective use of SDDI.
  
  
  METHODS
  In a first group of patients, dermatologists were adequately trained in optical dermoscopy but worked without access to SDDI. They excised all suspicious lesions to rule out melanoma. In a second group, the dermatologists were trained in optical and digital dermoscopy. They had the opportunity of choosing between immediate excision or follow-up by SDDI (with delayed excision if significant change was observed). The comparison of extra-costs in both groups was made possible by a decision tree model and by the division of the extra-costs by the number of melanomas diagnosed in each group. Belgian official tariffs and charges were used.
  
  
  RESULTS
  The extra-costs in the first and in the second group were respectively €1,613 and €1,052 per melanoma excised. The difference was statistically significant.
  
  
  CONCLUSIONS
  Using the Belgian official tariffs and charges, we demonstrated that the selective use of SDDI for patients with one-to-three atypical melanocytic lesions resulted in a significant cost reduction.
authors.affiliation: Department of Dermatology, Centre du Cancer, Cliniques Universitaires St Luc, Université catholique de Louvain, Brussels, Belgium.
authors.forename: Isabelle
authors.initials: I
authors.lastname: Tromme
authors.affiliation: Institute of Health and Society, Faculty of Public Health, Université catholique de Louvain, Brussels, Belgium.
authors.forename: Brecht
authors.initials: B
authors.lastname: Devleesschauwer
authors.affiliation: Centre for Health Economics Research & Modelling Infectious Diseases, Vaccine & Infectious Disease Institute, Faculty of Medicine & Health Sciences, University of Antwerp, Antwerp, Belgium.
authors.forename: Philippe
authors.initials: P
authors.lastname: Beutels
authors.affiliation: Department of Dermatology, Centre du Cancer, Cliniques Universitaires St Luc, Université catholique de Louvain, Brussels, Belgium.
authors.forename: Pauline
authors.initials: P
authors.lastname: Richez
authors.affiliation: Department of Biomedical Sciences, Institute of Tropical Medicine, Antwerp, Belgium.
authors.forename: Nicolas
authors.initials: N
authors.lastname: Praet
authors.affiliation: Department of Dermatology, Centre du Cancer, Cliniques Universitaires St Luc, Université catholique de Louvain, Brussels, Belgium.
authors.forename: Laurine
authors.initials: L
authors.lastname: Sacré
authors.affiliation: Department of Dermatology, Centre du Cancer, Cliniques Universitaires St Luc, Université catholique de Louvain, Brussels, Belgium.
authors.forename: Liliane
authors.initials: L
authors.lastname: Marot
authors.affiliation: Department of Dermatology, Centre du Cancer, Cliniques Universitaires St Luc, Université catholique de Louvain, Brussels, Belgium.
authors.forename: Pascal
authors.initials: P
authors.lastname: Van Eeckhout
authors.affiliation: Department of Dermatology, Centre du Cancer, Cliniques Universitaires St Luc, Université catholique de Louvain, Brussels, Belgium.
authors.forename: Ivan
authors.initials: I
authors.lastname: Theate
authors.affiliation: Department of Medical Oncology, Centre du Cancer, Cliniques Universitaires St Luc, Université catholique de Louvain, Brussels, Belgium.
authors.forename: Jean-François
authors.initials: JF
authors.lastname: Baurain
authors.affiliation: Department of Dermatology, Universitair Ziekenhuis, Antwerp, Belgium.
authors.forename: Julien
authors.initials: J
authors.lastname: Lambert
authors.affiliation: Institute of Statistics, Biostatistics and Actuarial Sciences, Université catholique de Louvain, Louvain-la-Neuve, Belgium.
authors.forename: Catherine
authors.initials: C
authors.lastname: Legrand
authors.affiliation: Department of Dermatology, Lyon 1 University, Centre Hospitalier Lyon Sud, Pierre Bénite, France.
authors.forename: Luc
authors.initials: L
authors.lastname: Thomas
authors.affiliation: Institute of Health and Society, Faculty of Public Health, Université catholique de Louvain, Brussels, Belgium.
authors.forename: Niko
authors.initials: N
authors.lastname: Speybroeck
mesh_terms: D000293:Adolescent; D000328:Adult; D000369:Aged, 80 and over; D001530:Belgium; D002648:Child; D002675:Child, Preschool; D003365:Costs and Cost Analysis; D046169:Dermoscopy / Q000295:instrumentation; D005260:Female; D006801:Humans; D008297:Male; D008545:Melanoma / Q000175:diagnosis* / Q000191:economics / Q000473:pathology; D008875:Middle Aged; D012878:Skin Neoplasms / Q000175:diagnosis* / Q000191:economics / Q000473:pathology; D044465:White People; D055815:Young Adult