Patients’ Confidence in Dermoscopical Methods for Detection of Malignant Melanoma

Abstract

Background: At present, different methods are available for the detection of malignant melanoma or for monitoring of melanocytic nevi (MN). Diagnostic accuracy and time consumption increase from naked-eye inspection (NEI) to handheld dermoscopy (HHD), digital dermoscopy (DD) including image analysis, and teledermoscopy (TD) supported by a specialist in dermoscopy. Effectiveness in daily routine depends on both physician’s experience and patient’s compliance. Objective: To analyse patient’s confidence in these diagnostic tools. Material and Methods: A self-administered survey was performed in consecutive patients after examination of MN at 13 private dermatological practices and at the Department of Dermatology of the University of Regensburg. Confidence was assessed by a 5-step ordinal scale ranging from 1 to 5 (higher values indicate higher confidence) and by willingness-to-pay (wtp) as health-economic instrument. Additionally, wtp was assessed for a hypothetical method promising 100% accuracy. Results: Data of 96 patients (mean age 35 years, 56% female) could be analysed. Mean confidence was 1.8 ± 0.9 for NEI, 2.9 ± 0.8 for HHD, 4.3 ± 0.6 for DD, and 4.8 ± 0.7 for TD. Mean wtp per examination was 0.6% ± 0.9 of monthly income (EUR 12.70 ± 15.40) for NEI, 1.2% ± 1.8 (EUR 23.60 ± 20.40) for HHD, 2.9% ± 3.1 (EUR 55.50 ± 42.30) for DD, 3.2% ± 3.9 (EUR 57.90 ± 42.60) for TD, and 5.3% ± 8.1 (EUR 96.10 ± 69.10) for the hypothetical method. Differences between methods were statistically significant (p < 0.001). Compared to the hypothetical method, NEI achieved only 13.2%, HHD 24.6%, DD 57.7%, and TD 60.2% of maximum confidence. Conclusions: Patients’ confidence was highest for TD, HHD was clearly underestimated. Wtp was similar for DD and TD – the best methods available at present – but still 40% lower than for a hypothetical diagnostic method providing 100% accuracy. Better information of patients about the diagnostic accuracy of different methods for detection of malignant melanoma is necessary in order to increase their confidence and compliance.

Use of and beliefs about total body photography and dermatoscopy among US dermatology training programs: An update

“…Interestingly, in a survey assessing confidence in various examination techniques for pigmented lesions, Schiffner et al 25 reported that patients are more confident with dermatoscopy compared with naked-eye examination.…”

Using Dermoscopic Criteria and Patient-Related Factors for the Management of Pigmented Melanocytic Nevi

“…1 need to excise a lesion. [11][12][13][14][15][16][17][18] Recent dermoscopy studies provide new understanding of factors that influence nevus pattern and offer intriguing insights into nevogenesis. Herein, we present a synopsis of the most common dermoscopic patterns associated with nevi and the factors influencing the nevus pattern in a given individual, and we discuss some of the recent concepts of nevogenesis.…”

Screening and Non-Invasive Evaluative Devices for Melanoma Detection A Comparison of Commercially Available Devices and Dermoscopic Evaluation

“…While these results appear promising, another study comparing SDDI to TBP found that SDDI resulted in a significantly higher number of biopsies per patient (1.1 with SDDI versus 0.59 for TBP; p <0.001), possible lower melanoma detection rates (2.2% with SDDI versus 5.5% with TBP; p = 0.088) and longer estimated times for clinic appointments [7]. Two studies examining the use of SDDI in patients without at least one risk factor for melanoma (representing a low-risk population) failed to identify any malignancies despite median follow up durations of 6 and 24 months [30,31]. These results, in conjunction with the high biopsy ratio of 79:1 in the low risk arm of the Haenssle et al, trial; suggest that SDDI is of most utility in the high-risk groups [23].…”

“…Dermoscopy (also called epiluminescence microscopy) improves biopsy ratios by enhancing the diagnostic confidence of providers, and has been extensively reviewed in the literature [35,36]. Melanoma diagnosis with dermoscopy is subjective and varies with provider experience [30,37,38]. Consequently, Automated Dermoscopic Diagnostic (ADD) programs have been applied to dermoscopy images in an attempt to reduce subjective analysis.…”