title: Influence of Ambient Stressors and Time Constraints on Diagnostic Accuracy of Borderline Pigmented Skin Lesions.
abstract: BACKGROUND
  Health professionals are required to make complex decisions in dynamic contexts involving many variables and factors. Decisions are more difficult in the presence of uncertainty, urgency and high risk.
  
  
  OBJECTIVE
  To evaluate the effect of ambient stressors and time constraints on decision making by expert dermatologists faced with borderline pigmented skin lesions (PSL) (early melanoma vs. atypical nevi).
  
  
  METHODS
  We performed a retrospective chart review of PSL from the image databases of our department. A total of 321 PSL (219 nevi and 102 melanomas) were randomly assigned to three groups: control group, ambient stress group and time stress group. The diagnostic accuracy of each group was evaluated as sensitivity and specificity.
  
  
  RESULTS
  Mean sensitivity and specificity of diagnosis were 69.2 and 90.5% in the control group, 62 and 81.2% in the ambient stress group and 59.6 and 82.5% in the time stress group, respectively.
  
  
  CONCLUSIONS
  Time constraints and stressors negatively influenced the performance of dermatologists in the diagnosis of atypical PSL.
authors.affiliation: Dermatology Section, Department of Medical, Surgical and Neurological Science, Siena University Hospital, Siena, Italy.
authors.forename: Luca
authors.initials: L
authors.lastname: Feci
authors.forename: Gabriele
authors.initials: G
authors.lastname: Cevenini
authors.forename: Niccolò
authors.initials: N
authors.lastname: Nami
authors.forename: Alberto
authors.initials: A
authors.lastname: Fagiolini
authors.forename: Roberto
authors.initials: R
authors.lastname: Perotti
authors.forename: Clelia
authors.initials: C
authors.lastname: Miracco
authors.forename: Michele
authors.initials: M
authors.lastname: Fimiani
authors.forename: Pietro
authors.initials: P
authors.lastname: Rubegni
mesh_terms: D046169:Dermoscopy / Q000379:methods*; D003937:Diagnosis, Differential; D005500:Follow-Up Studies; D006801:Humans; D010859:Pigmentation Disorders / Q000175:diagnosis* / Q000209:etiology; D012372:ROC Curve; D015203:Reproducibility of Results; D012189:Retrospective Studies; D012867:Skin / Q000473:pathology*; D013315:Stress, Psychological / Q000150:complications*