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Meta-Analysis
. 2018 Dec 4;12(12):CD011902.
doi: 10.1002/14651858.CD011902.pub2.

Dermoscopy, with and without visual inspection, for diagnosing melanoma in adults

Jacqueline Dinnes  1 , Jonathan J Deeks, Naomi Chuchu, Lavinia Ferrante di Ruffano, Rubeta N Matin, David R Thomson, Kai Yuen Wong, Roger Benjamin Aldridge, Rachel Abbott, Monica Fawzy, Susan E Bayliss, Matthew J Grainge, Yemisi Takwoingi, Clare Davenport, Kathie Godfrey, Fiona M Walter, Hywel C Williams; Cochrane Skin Cancer Diagnostic Test Accuracy Group
Affiliations
Meta-Analysis

Dermoscopy, with and without visual inspection, for diagnosing melanoma in adults

Jacqueline Dinnes et al. Cochrane Database Syst Rev. .

Abstract

Background: Melanoma has one of the fastest rising incidence rates of any cancer. It accounts for a small percentage of skin cancer cases but is responsible for the majority of skin cancer deaths. Although history-taking and visual inspection of a suspicious lesion by a clinician are usually the first in a series of 'tests' to diagnose skin cancer, dermoscopy has become an important tool to assist diagnosis by specialist clinicians and is increasingly used in primary care settings. Dermoscopy is a magnification technique using visible light that allows more detailed examination of the skin compared to examination by the naked eye alone. Establishing the additive value of dermoscopy over and above visual inspection alone across a range of observers and settings is critical to understanding its contribution for the diagnosis of melanoma and to future understanding of the potential role of the growing number of other high-resolution image analysis techniques.

Objectives: To determine the diagnostic accuracy of dermoscopy alone, or when added to visual inspection of a skin lesion, for the detection of cutaneous invasive melanoma and atypical intraepidermal melanocytic variants in adults. We separated studies according to whether the diagnosis was recorded face-to-face (in-person), or based on remote (image-based), assessment.

Search methods: We undertook a comprehensive search of the following databases from inception up to August 2016: CENTRAL; MEDLINE; Embase; CINAHL; CPCI; Zetoc; Science Citation Index; US National Institutes of Health Ongoing Trials Register; NIHR Clinical Research Network Portfolio Database; and the World Health Organization International Clinical Trials Registry Platform. We studied reference lists and published systematic review articles.

Selection criteria: Studies of any design that evaluated dermoscopy in adults with lesions suspicious for melanoma, compared with a reference standard of either histological confirmation or clinical follow-up. Data on the accuracy of visual inspection, to allow comparisons of tests, was included only if reported in the included studies of dermoscopy.

Data collection and analysis: Two review authors independently extracted all data using a standardised data extraction and quality assessment form (based on QUADAS-2). We contacted authors of included studies where information related to the target condition or diagnostic threshold were missing. We estimated accuracy using hierarchical summary receiver operating characteristic (SROC),methods. Analysis of studies allowing direct comparison between tests was undertaken. To facilitate interpretation of results, we computed values of sensitivity at the point on the SROC curve with 80% fixed specificity and values of specificity with 80% fixed sensitivity. We investigated the impact of in-person test interpretation; use of a purposely developed algorithm to assist diagnosis; observer expertise; and dermoscopy training.

Main results: We included a total of 104 study publications reporting on 103 study cohorts with 42,788 lesions (including 5700 cases), providing 354 datasets for dermoscopy. The risk of bias was mainly low for the index test and reference standard domains and mainly high or unclear for participant selection and participant flow. Concerns regarding the applicability of study findings were largely scored as 'high' concern in three of four domains assessed. Selective participant recruitment, lack of reproducibility of diagnostic thresholds and lack of detail on observer expertise were particularly problematic.The accuracy of dermoscopy for the detection of invasive melanoma or atypical intraepidermal melanocytic variants was reported in 86 datasets; 26 for evaluations conducted in person (dermoscopy added to visual inspection), and 60 for image-based evaluations (diagnosis based on interpretation of dermoscopic images). Analyses of studies by prior testing revealed no obvious effect on accuracy; analyses were hampered by the lack of studies in primary care, lack of relevant information and the restricted inclusion of lesions selected for biopsy or excision. Accuracy was higher for in-person diagnosis compared to image-based evaluations (relative diagnostic odds ratio (RDOR) 4.6, 95% confidence interval (CI) 2.4 to 9.0; P < 0.001).We compared accuracy for (a), in-person evaluations of dermoscopy (26 evaluations; 23,169 lesions and 1664 melanomas),versus visual inspection alone (13 evaluations; 6740 lesions and 459 melanomas), and for (b), image-based evaluations of dermoscopy (60 evaluations; 13,475 lesions and 2851 melanomas),versus image-based visual inspection (11 evaluations; 1740 lesions and 305 melanomas). For both comparisons, meta-analysis found dermoscopy to be more accurate than visual inspection alone, with RDORs of (a), 4.7 (95% CI 3.0 to 7.5; P < 0.001), and (b), 5.6 (95% CI 3.7 to 8.5; P < 0.001). For a), the predicted difference in sensitivity at a fixed specificity of 80% was 16% (95% CI 8% to 23%; 92% for dermoscopy + visual inspection versus 76% for visual inspection), and predicted difference in specificity at a fixed sensitivity of 80% was 20% (95% CI 7% to 33%; 95% for dermoscopy + visual inspection versus 75% for visual inspection). For b) the predicted differences in sensitivity was 34% (95% CI 24% to 46%; 81% for dermoscopy versus 47% for visual inspection), at a fixed specificity of 80%, and predicted difference in specificity was 40% (95% CI 27% to 57%; 82% for dermoscopy versus 42% for visual inspection), at a fixed sensitivity of 80%.Using the median prevalence of disease in each set of studies ((a), 12% for in-person and (b), 24% for image-based), for a hypothetical population of 1000 lesions, an increase in sensitivity of (a), 16% (in-person), and (b), 34% (image-based), from using dermoscopy at a fixed specificity of 80% equates to a reduction in the number of melanomas missed of (a), 19 and (b), 81 with (a), 176 and (b), 152 false positive results. An increase in specificity of (a), 20% (in-person), and (b), 40% (image-based), at a fixed sensitivity of 80% equates to a reduction in the number of unnecessary excisions from using dermoscopy of (a), 176 and (b), 304 with (a), 24 and (b), 48 melanomas missed.The use of a named or published algorithm to assist dermoscopy interpretation (as opposed to no reported algorithm or reported use of pattern analysis), had no significant impact on accuracy either for in-person (RDOR 1.4, 95% CI 0.34 to 5.6; P = 0.17), or image-based (RDOR 1.4, 95% CI 0.60 to 3.3; P = 0.22), evaluations. This result was supported by subgroup analysis according to algorithm used. We observed higher accuracy for observers reported as having high experience and for those classed as 'expert consultants' in comparison to those considered to have less experience in dermoscopy, particularly for image-based evaluations. Evidence for the effect of dermoscopy training on test accuracy was very limited but suggested associated improvements in sensitivity.

Authors' conclusions: Despite the observed limitations in the evidence base, dermoscopy is a valuable tool to support the visual inspection of a suspicious skin lesion for the detection of melanoma and atypical intraepidermal melanocytic variants, particularly in referred populations and in the hands of experienced users. Data to support its use in primary care are limited, however, it may assist in triaging suspicious lesions for urgent referral when employed by suitably trained clinicians. Formal algorithms may be of most use for dermoscopy training purposes and for less expert observers, however reliable data comparing approaches using dermoscopy in person are lacking.

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Conflict of interest statement

Jacqueline Dinnes: nothing to declare. Jonathan J Deeks: nothing to declare. Naomi Chuchu: nothing to declare. Lavinia Ferrante di Ruffano: nothing to declare. Rubeta N Matin: my institution received a grant for a Barco NV commercially sponsored study to evaluate digital dermoscopy in the skin cancer clinic. My institution also received Oxfordshire Health Services Research Charitable Funds for carrying out a study of feasibility of using the Skin Cancer Quality of Life Impact Tool (SCQOLIT) in non melanoma skin cancer. I have received payment from Public Health England for the "Be Clear on Cancer Skin Cancer" report and royalties for the Oxford Handbook of Medical Dermatology (Oxford University Press). I have no conflicts of interest to declare that directly relate to the publication of this work. David R Thomson: nothing to declare. Kai Yuen Wong: nothing to declare. Roger Benjamin Aldridge: nothing to declare. Rachel Abbott: nothing to declare. Monica Fawzy: nothing to declare. Susan E Bayliss: nothing to declare. Matthew J Grainge: nothing to declare. Yemisi Takwoingi: nothing to declare. Clare Davenport: nothing to declare. Kathie Godfrey: nothing to declare. Fiona M Walter: nothing to declare. Hywel C Williams: I am director of the NIHR HTA Programme. HTA is part of the NIHR which also supports the NIHR systematic reviews programme from which this work is funded.

Figures

1
1
Sample photographs of superficial spreading melanoma (left) and nodular melanoma (right). Copyright © 2010 Dr Rubeta Matin: reproduced with permission.
2
2
Current clinical pathway for people with skin lesions.
3
3
Clinical pathway
4
4
PRISMA flow diagram.
5
5
Risk of bias and applicability concerns graph for in‐person evaluations: review authors' judgements about each domain presented as percentages across included studies
6
6
Risk of bias and applicability concerns for in‐person evaluations summary: review authors' judgements about each domain for each included study
7
7
Risk of bias and applicability concerns graph for image‐based evaluations: review authors' judgements about each domain presented as percentages across included studies
8
8
Risk of bias and applicability concerns for image‐based evaluations summary: review authors' judgements about each domain for each included study
9
9
In‐person evaluations of the accuracy of dermoscopy added to visual inspection grouped by pathway categorisation for detecting invasive melanoma or atypical intraepidermal melanocytic variants
10
10
Image‐based evaluations of the accuracy of dermoscopy grouped by pathway categorisation for detecting for detecting invasive melanoma or atypical intraepidermal melanocytic variants
11
11
Comparison of the accuracy of visual inspection with visual inspection (VI) + dermoscopy for detection of invasive melanoma or atypical intraepidermal melanocytic variants from in‐person studies
12
12
Paired comparisons of the accuracy of visual inspection with visual inspection (VI) + dermoscopy for detection of invasive melanoma or atypical intraepidermal melanocytic variants from in‐person studies
13
13
Comparison of the accuracy of visual inspection with dermoscopy for detection of invasive melanoma or atypical intraepidermal melanocytic variants from image‐based studies
14
14
Paired comparison of the accuracy of visual inspection versus dermoscopy for detection of invasive melanoma or atypical intraepidermal melanocytic variants from paired image‐based studies
15
15
Comparison of the accuracy of dermoscopy for detection of invasive melanoma or atypical intraepidermal melanocytic variants between in‐person (visual inspection + dermoscopy) and image‐based (dermoscopy) studies
16
16
Comparison of the accuracy of visual inspection + dermoscopy for detection of invasive melanoma or atypical intraepidermal melanocytic variants from in‐person studies according to reported observer experience
17
17
Comparison of the accuracy of dermoscopy for detection of invasive melanoma or atypical intraepidermal melanocytic variants from image‐based studies according to observer experience
18
18
Comparison of the accuracy of visual inspection + dermoscopy for detection of invasive melanoma or atypical intraepidermal melanocytic variants from in‐person studies according to observer qualifications (summary receiver operating characteristic (ROC) curves were not estimable from the model for 'resident/registrar' and 'mixed (secondary care‐based)' experience groups)
19
19
Comparison of the accuracy of dermoscopy for detection of invasive melanoma or atypical intraepidermal melanocytic variants from image‐based studies according to observer qualification. (Hierarchical summary receiver operating characteristic (HSROC) curves could not be estimated for 'mixed (secondary care‐based)' and 'physician assistant' groups)
20
20
Comparison of the accuracy of visual inspection with visual inspection (VI) + dermoscopy for detection of invasive melanoma from in‐person studies
21
21
Comparison of the accuracy of visual inspection with dermoscopy for detection of invasive melanoma from image‐based studies
22
22
Forest plot of tests. 9 Visual inspection ‐ in‐person (any skin cancer), 10 VI+dermoscopy ‐ in‐person (any skin cancer)
23
23
Forest plot of tests. 11 Visual inspection ‐ image‐based (any skin cancer), 12 dermoscopy alone ‐ image‐based (any skin cancer)
24
24
Forest plot of tests. Accuracy of dermoscopy before and after dermoscopy training (MM and invasive melanoma or atypical intraepidermal melanocytic variants)
25
25
Forest plot of tests. 5 Visual inspection ‐ in‐person (invasive melanoma or atypical intraepidermal melanocytic variants), 7 visual inspection ‐ image‐based (invasive melanoma or atypical intraepidermal melanocytic variants)
26
26
Forest plot of tests. 1 Visual inspection ‐ in‐person (invasive melanoma), 2 VI+dermoscopy ‐ in‐person (invasive melanoma)
27
27
Forest plot of tests. 3 Visual inspection ‐ image‐based (invasive melanoma), 4 dermoscopy alone ‐ image‐based (invasive melanoma)
1
1. Test
Visual inspection ‐ in‐person (invasive melanoma).
2
2. Test
VI+dermoscopy ‐ in‐person (invasive melanoma).
3
3. Test
Visual inspection ‐ image‐based (invasive melanoma).
4
4. Test
Dermoscopy alone ‐ image‐based (invasive melanoma).
5
5. Test
Visual inspection ‐ in‐person (invasive melanoma or atypical intraepidermal melanocytic variants).
6
6. Test
VI+dermoscopy ‐ in‐person (invasive melanoma or atypical intraepidermal melanocytic variants).
7
7. Test
Visual inspection ‐ image‐based (invasive melanoma or atypical intraepidermal melanocytic variants).
8
8. Test
Dermoscopy alone ‐ image‐based (invasive melanoma or atypical intraepidermal melanocytic variants).
9
9. Test
Visual inspection ‐ in‐person (any).
10
10. Test
VI+Dermoscopy ‐ in‐person (Any).
11
11. Test
Visual inspection ‐ image‐based (any).
12
12. Test
Dermoscopy alone ‐ image‐based (any).
13
13. Test
MM2‐ Dermoscopy ‐ no algorithm ‐ threshold NR ‐ in‐person.
14
14. Test
MM2‐ Dermoscopy ‐ pattern ‐ at ≥ 1 char present ‐ in‐person.
15
15. Test
MM2‐ Dermoscopy ‐ pattern ‐ at ≥ 3 characteristics present ‐ in‐person.
16
16. Test
MM2‐ Dermoscopy ‐ pattern ‐ threshold NR ‐ in‐person.
17
17. Test
MM2‐ Dermoscopy ‐ ABCD at NR (likely > 5.45) ‐ in‐person.
18
18. Test
MM2‐ Dermoscopy ‐ ABCD at > 5.45 ‐ in‐person.
19
19. Test
MM2‐ Dermoscopy ‐ ABCD at > 4.75 ‐ in‐person.
20
20. Test
MM2‐ Dermoscopy ‐ ABCD at 60% specificity ‐ in‐person.
21
21. Test
MM2‐ Dermoscopy ‐ ABCD at 80% specificity ‐ in‐person.
22
22. Test
MM2‐ Dermoscopy ‐ ABCD at 70% specificity ‐ in‐person.
23
23. Test
MM2‐ Dermoscopy ‐ ABCD at 75% specificity ‐ in‐person.
24
24. Test
MM2‐ Dermoscopy ‐ ABCD at 85% specificity ‐ in‐person.
25
25. Test
MM2‐ Dermoscopy ‐ ABCD at 90% specificity ‐ in‐person.
26
26. Test
MM2‐ Dermoscopy ‐ ABCDE at > 1.3 ‐ in‐person.
27
27. Test
MM2‐ Dermoscopy ‐ ABCDE at > 2.65 ‐ in‐person.
28
28. Test
MM2‐ Dermoscopy ‐ ABCDE at > 3.05 ‐ in‐person.
29
29. Test
MM2‐ Dermoscopy ‐ ABCDE at > 3.6 ‐ in‐person.
30
30. Test
MM2‐ Dermoscopy ‐ ABCDE at > 4.25 ‐ in‐person.
31
31. Test
MM2‐ Dermoscopy ‐ ABCDE at > 4.9 ‐ in‐person.
32
32. Test
MM2‐ Dermoscopy ‐ 7FFM at ≥ 2 ‐ in‐person.
33
33. Test
MM2‐ Dermoscopy ‐ 7‐point at ≥ 2 ‐ in‐person.
34
34. Test
MM2‐ Dermoscopy ‐ 7‐point at ≥ 3 ‐ in‐person.
35
35. Test
MM2‐ Dermoscopy ‐ Menzies at 2 negative and ≥ 1 positive ‐ in‐person.
36
36. Test
MM2‐ Dermoscopy ‐ no algorithm ‐ any threshold ‐ image‐based.
37
37. Test
MM2‐ Dermoscopy ‐ no algorithm ‐ correct diagnosis ‐ image‐based.
38
38. Test
MM2‐ Dermoscopy ‐ no algorithm ‐ excise decision ‐ image‐based.
39
39. Test
MM2‐ Dermoscopy ‐ pattern ‐ any threshold ‐ image‐based.
40
40. Test
MM2‐ Dermoscopy ‐ pattern ‐ correct diagnosis ‐ image‐based.
41
41. Test
MM2‐ Dermoscopy ‐ pattern ‐ excise decision ‐ image‐based.
42
42. Test
MM2‐ Dermoscopy ‐ ABCD at > 4.75 ‐ image‐based.
43
43. Test
MM2‐ Dermoscopy ‐ ABCD at > 5.45 ‐ image‐based.
44
44. Test
MM2‐ Dermoscopy ‐ revised ABCD at ≥ 4 ‐ image‐based.
45
45. Test
MM2‐ Dermoscopy ‐ ABCDE at ≥ 4 ‐ image‐based.
46
46. Test
MM2‐ Dermoscopy ‐ 7‐point at NR ‐ image‐based.
47
47. Test
MM2‐ Dermoscopy ‐ 7‐point at ≥ 3 ‐ image‐based.
48
48. Test
MM2‐ Dermoscopy ‐ 7‐point at ≥ 5 ‐ image‐based.
49
49. Test
MM2‐ Dermoscopy ‐ revised 7‐point at NR (likely ≥ 1) ‐ image‐based.
50
50. Test
MM2‐ Dermoscopy – revised 7‐point at ≥ 1 ‐ image‐based.
51
51. Test
MM2‐ Dermoscopy ‐ revised 7‐point for FU ‐ major change ‐ image‐based.
52
52. Test
MM2‐ Dermoscopy ‐ 7FFM at ≥ 2 ‐ image‐based.
53
53. Test
MM2‐ Dermoscopy ‐ Menzies at 2 negative and ≥ 1 positive ‐ image‐based.
54
54. Test
MM2‐ Dermoscopy ‐ Menzies at NR ‐ image‐based.
55
55. Test
MM2‐ Dermoscopy ‐ 3‐point at ≥ 2 ‐ image‐based.
56
56. Test
MM2‐ Dermoscopy ‐ 4‐point (scored 3‐point) at > 2 ‐ image‐based.
57
57. Test
MM2‐ Dermoscopy ‐ Hofman algorithm at NR ‐ image‐based.
58
58. Test
MM2‐ Dermoscopy CASH at ≥ 6 ‐ image‐based.
59
59. Test
MM2‐ Dermoscopy CASH at ≥ 8 ‐ image‐based.
60
60. Test
MM2‐ Dermoscopy Chaos/Clues at = 2 ‐ image‐based.
61
61. Test
MM2‐ Dermoscopy ‐ Acral 3‐step ‐ image‐based.
62
62. Test
VI+dermoscopy (in‐person) ‐ observer experience NR (invasive melanoma or atypical intraepidermal melanocytic variants).
63
63. Test
VI+dermoscopy (in‐person) ‐ high experience (invasive melanoma or atypical intraepidermal melanocytic variants).
65
65. Test
VI+dermoscopy (in‐person) ‐ trained observer (invasive melanoma or atypical intraepidermal melanocytic variants).
66
66. Test
Dermoscopy (image‐based) ‐ observer experience NR (invasive melanoma or atypical intraepidermal melanocytic variants).
67
67. Test
Dermoscopy (image‐based) ‐ high experience (invasive melanoma or atypical intraepidermal melanocytic variants).
68
68. Test
Dermoscopy (image‐based) ‐ moderate experience (invasive melanoma or atypical intraepidermal melanocytic variants).
69
69. Test
Dermoscopy (image‐based) ‐ low experience (invasive melanoma or atypical intraepidermal melanocytic variants).
70
70. Test
Dermoscopy (image‐based) ‐ mixed experience (invasive melanoma or atypical intraepidermal melanocytic variants).
71
71. Test
Dermoscopy (image‐based) ‐ trained observer (invasive melanoma or atypical intraepidermal melanocytic variants).
72
72. Test
VI+dermoscopy (in‐person) ‐ consultant expert (invasive melanoma or atypical intraepidermal melanocytic variants).
73
73. Test
VI+dermoscopy (in‐person) ‐ consultant (invasive melanoma or atypical intraepidermal melanocytic variants).
74
74. Test
VI+dermoscopy (in‐person) ‐ resident/registrar (invasive melanoma or atypical intraepidermal melanocytic variants).
75
75. Test
VI+dermoscopy (in‐person) ‐ mixed (secondary care‐based) (invasive melanoma or atypical intraepidermal melanocytic variants).
76
76. Test
VI+dermoscopy (in‐person) ‐ GP (invasive melanoma or atypical intraepidermal melanocytic variants).
77
77. Test
Dermoscopy (image‐based) ‐ consultant expert (invasive melanoma or atypical intraepidermal melanocytic variants).
78
78. Test
Dermoscopy (image‐based) ‐ consultant (invasive melanoma or atypical intraepidermal melanocytic variants).
79
79. Test
Dermoscopy (image‐based) ‐ resident (invasive melanoma or atypical intraepidermal melanocytic variants).
80
80. Test
Dermoscopy (image‐based) ‐ mixed (secondary care based) (invasive melanoma or atypical intraepidermal melanocytic variants).
81
81. Test
Dermoscopy (image‐based) ‐ mixed (other) (invasive melanoma or atypical intraepidermal melanocytic variants).
82
82. Test
Dermoscopy (image‐based) ‐ GP/primary care (invasive melanoma or atypical intraepidermal melanocytic variants).
83
83. Test
Dermoscopy (image‐based) ‐ physician assistant (invasive melanoma or atypical intraepidermal melanocytic variants).
84
84. Test
Dermoscopy ‐ before training (invasive melanoma or atypical intraepidermal melanocytic variants).
85
85. Test
Dermoscopy ‐ after training (invasive melanoma or atypical intraepidermal melanocytic variants).
86
86. Test
Dermoscopy ‐ before training (invasive melanoma).
87
87. Test
Dermoscopy ‐ after training (invasive melanoma).
88
88. Test
MM1‐ Dermoscopy ‐ no algorithm ‐ threshold NR ‐ in‐person.
89
89. Test
MM1‐ Dermoscopy ‐ pattern analysis ‐ threshold NR ‐ in‐person.
90
90. Test
MM1‐ Dermoscopy ‐ ABCD at > 4.2 ‐ in‐person.
91
91. Test
MM1‐ Dermoscopy ‐ ABCD at > 5.45 ‐ in‐person.
92
92. Test
MM1‐ Dermoscopy ‐ Kenet (modified) at melanoma possible ‐ in‐person.
93
93. Test
MM1‐ Dermoscopy ‐ Kenet (modified) at melanoma likely ‐ in‐person.
94
94. Test
MM1‐ Dermoscopy ‐ no algorithm ‐ threshold NR ‐ image‐based.
95
95. Test
MM1‐ Dermoscopy ‐ no algorithm ‐ decision to excise ‐ image‐based (paired data only).
96
96. Test
MM1‐ Dermoscopy ‐ pattern analysis ‐ threshold NR ‐ image‐based.
97
97. Test
MM1‐ Dermoscopy ‐ ABCD at > 4.75 ‐ image‐based.
98
98. Test
MM1‐ Dermoscopy ‐ ABCD at > 5.45 ‐ image‐based.
99
99. Test
MM1‐ Dermoscopy ‐ 7‐point at NR ‐ image‐based.
100
100. Test
MM1‐ Dermoscopy ‐ Menzies at 2 negative and ≥ 1 positive ‐ image‐based.
101
101. Test
MM1‐ Dermoscopy ‐ 3‐point at > NR ‐ image‐based.
102
102. Test
MM1‐ Dermoscopy ‐ Kenet at melanoma likely ‐ image‐based.
103
103. Test
MM1‐ Dermoscopy ‐ Kenet at melanoma possible ‐ image‐based.
104
104. Test
MM1‐ Dermoscopy CASH at ≥ 8 ‐ image‐based.
105
105. Test
MM1‐ Dermoscopy ‐ Kreusch algorithm ‐ image‐based.
106
106. Test
MM1‐ Dermoscopy ‐ Menzies for amelanotic at 1 ‐ image‐based.
107
107. Test
MM1‐ Dermoscopy ‐ Menzies for amelanotic at 0 ‐ image‐based.
108
108. Test
MM3‐ Dermoscopy – no algorithm at NR ‐ in‐person.
109
109. Test
MM3‐ Dermoscopy ‐ pattern analysis ‐ threshold NR ‐ in‐person.
110
110. Test
MM3‐ Dermoscopy – ABCD at > 5.45 ‐ in‐person.
111
111. Test
MM3‐ Dermoscopy – 3‐point at ≥ 2 ‐ in‐person.
112
112. Test
MM3‐ Dermoscopy – no algorithm at NR ‐ image‐based.
113
113. Test
MM3‐ Dermoscopy ‐ pattern analysis ‐ threshold NR ‐ image‐based.
114
114. Test
MM3‐ Dermoscopy – 3‐point at ≥ 2 ‐ image‐based.
115
115. Test
MM2 ‐ VI ‐ in‐person (with image‐based dermoscopy).
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References

References to studies included in this review

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Argenziano 1998 {published data only}
    1. Argenziano G, Fabbrocini G, Carli P, Giorgi V, Sammarco E, Delfino M. Epiluminescence microscopy for the diagnosis of doubtful melanocytic skin lesions. Comparison of the ABCD rule of dermatoscopy and a new 7‐point checklist based on pattern analysis. Archives of Dermatology 1998;134(12):1563‐70. [ER4:15465850; PUBMED: 9875194] - PubMed
Argenziano 2006 {published data only}
    1. Argenziano G, Puig S, Zalaudek I, Sera F, Corona R, Alsina M, et al. Dermoscopy improves accuracy of primary care physicians to triage lesions suggestive of skin cancer. Journal of Clinical Oncology 2006;24(12):1877‐82. [ER4:17940973; PUBMED: 16622262] - PubMed
Argenziano 2011 {published data only}
    1. Argenziano G, Catricala C, Ardigo M, Buccini P, Simone P, Eibenschutz L, et al. Seven‐point checklist of dermoscopy revisited. British Journal of Dermatology 2011;164(4):785‐90. [ER4:15465848; PUBMED: 21175563] - PubMed
Ascierto 2010 {published data only}
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Bauer 2000 {published data only}
    1. Bauer P, Cristofolini P, Boi S, Burroni M, Dell'Eva G, Micciolo R, et al. Digital epiluminescence microscopy: usefulness in the differential diagnosis of cutaneous pigmentary lesions. A statistical comparison between visual and computer inspection. Melanoma Research 2000;10(4):345‐9. [ER4:15465861; PUBMED: 10985668] - PubMed
Benelli 1999 {published data only}
    1. Benelli C, Roscetti E, Pozzo VD, Gasparini G, Cavicchini S. The dermoscopic versus the clinical diagnosis of melanoma. European Journal of Dermatology 1999;9(6):470‐6. [ER4:18375029; PUBMED: 10491506] - PubMed
Benelli 2000a {published data only}
    1. Benelli C, Roscetti E, Dal Pozzo V. The dermoscopic (7FFM) versus the clinical (ABCDE) diagnosis of small diameter melanoma. European Journal of Dermatology 2000;10(4):282‐7. [PUBMED: 10846255] - PubMed
Benelli 2001 {published data only}
    1. Benelli C, Roscetti E, Dal Pozzo V. Reproducibility of the clinical criteria (ABCDE rule) and dermatoscopic features (7FFM) for the diagnosis of malignant melanoma. European Journal of Dermatology 2001;11(3):234‐9. [ER4:18375028; PUBMED: 11358731] - PubMed
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    1. Binder M, Steiner A, Schwarz M, Knollmayer S, Wolff K, Pehamberger H. Application of an artificial neural network in epiluminescence microscopy pattern analysis of pigmented skin lesions: a pilot study. British Journal of Dermatology 1994;130(4):460‐5. [ER4:18375032; PUBMED: 8186110] - PubMed
Binder 1995 {published data only}
    1. Binder M, Schwarz M, Winkler A, Steiner A, Kaider A, Wolff K, et al. Epiluminescence microscopy. A useful tool for the diagnosis of pigmented skin lesions for formally trained dermatologists. Archives of Dermatology 1995;131(3):286‐91. [ER4:18375031; PUBMED: 7887657] - PubMed
Binder 1999 {published data only}
    1. Binder M, Kittler H, Steiner A, Dawid M, Pehamberger H, Wolff K. Reevaluation of the ABCD rule for epiluminescence microscopy. Journal of the American Academy of Dermatology 1999;40(2 Pt 1):171‐6. [ER4:15465864; PUBMED: 10025741] - PubMed
Blum 2003a {published data only}
    1. Blum A, Rassner G, Garbe C. Modified ABC‐point list of dermoscopy: a simplified and highly accurate dermoscopic algorithm for the diagnosis of cutaneous melanocytic lesions. Journal of the American Academy of Dermatology 2003;48(5):672‐8. [ER4:15465867; PUBMED: 12734495] - PubMed
Blum 2003b {published data only}
    1. Blum A, Soyer HP, Garbe C, Kerl H, Rassner G, Hofmann‐Wellenhof R. The dermoscopic classification of atypical melanocytic naevi (Clark naevi) is useful to discriminate benign from malignant melanocytic lesions. British Journal of Dermatology 2003;149(6):1159‐64. [ER4:15465868; PUBMED: 14674892] - PubMed
Blum 2004a {published data only}
    1. Blum A, Hofmann‐Wellenhof R, Luedtke H, Ellwanger U, Steins A, Roehm S, et al. Value of the clinical history for different users of dermoscopy compared with results of digital image analysis. Journal of the European Academy of Dermatology & Venereology 2004;18(6):665‐9. [ER4:15465865; PUBMED: 15482291] - PubMed
Blum 2004b {published data only}
    1. Blum A, Luedtke H, Ellwanger U, Schwabe R, Rassner G, Garbe C. Digital image analysis for diagnosis of cutaneous melanoma. Development of a highly effective computer algorithm based on analysis of 837 melanocytic lesions. British Journal of Dermatology 2004;151(5):1029‐38. [ER4:15465866; PUBMED: 15541081] - PubMed
Bono 2002a {published data only}
    1. Bono A, Bartoli C, Cascinelli N, Lualdi M, Maurichi A, Moglia D, et al. Melanoma detection. A prospective study comparing diagnosis with the naked eye, dermatoscopy and telespectrophotometry. Dermatology 2002;205(4):362‐6. [ER4:15465870; PUBMED: 12444332] - PubMed
Bono 2002b {published data only}
    1. Bono A, Bartoli C, Baldi M, Tomatis S, Bifulco C, Santinami M. Clinical and dermatoscopic diagnosis of small pigmented skin lesions. European Journal of Dermatology 2002;12(6):573‐6. [ER4:18375034; PUBMED: 12459531] - PubMed
Bono 2006 {published data only}
    1. Bono A, Tolomio E, Trincone S, Bartoli C, Tomatis S, Carbone A, et al. Micro‐melanoma detection: a clinical study on 206 consecutive cases of pigmented skin lesions with a diameter < or = 3 mm. British Journal of Dermatology 2006;155(3):570‐3. [ER4:15465872; PUBMED: 16911283] - PubMed
Bourne 2012 {published data only}
    1. Bourne P, Rosendahl C, Keir J, Cameron A. BLINCK‐A diagnostic algorithm for skin cancer diagnosis combining clinical features with dermatoscopy findings. Dermatology Practical & Conceptual 2012;2(2):202a12. [ER4:17941081; PUBMED: 23785600] - PMC - PubMed
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    1. Broganelli P, Chiaretta A, Sacerdote C, Pippione M. The epiluminescence microscopy in the ambulatory clinical practice: diagnostic accuracy and usefulness of videodermatoscopic monitoring [L'epiluminescenza nella pratica clinica ambulatoriale: accuratezza diagnostica ed utilita del monitoraggio videodermatoscopico]. Giornale Italiano di Dermatologia e Venereologia 2005;140(1):15‐25. [ER4:18375073]
Carli 1994 {published data only}
    1. Carli P, Giorgi V, Donati E, Pestelli E, Giannotti B. Epiluminescence microscopy reduces the risk of removing clinically atypical, but histologically common, melanocytic lesions [La microscopia a epiluminescenza (Elm) riduce il rischio di asportare lesioni melanocitarie clinicamente sospette ma istologicamente comuni]. Giornale Italiano di Dermatologia e Venereologia 1994;129(12):599‐605. [ER4:18375075]
Carli 2002a {published data only}
    1. Carli P, Giorgi V, Argenziano G, Palli D, Giannotti B. Pre‐operative diagnosis of pigmented skin lesions: in vivo dermoscopy performs better than dermoscopy on photographic images. Journal of the European Academy of Dermatology & Venereology 2002;16(4):339‐46. [ER4:15465882; PUBMED: 12224689] - PubMed
Carli 2002b {published data only}
    1. Carli P, Giorgi V, Salvini C, Mannone F, Chiarugi A. The gold standard for photographing pigmented skin lesions for diagnostic purposes: contact versus distant imaging. Skin Research & Technology 2002;8(4):255‐9. [ER4:15465888; PUBMED: 12423545] - PubMed
Carli 2003a {published data only}
    1. Carli P, Quercioli E, Sestini S, Stante M, Ricci L, Brunasso G, et al. Pattern analysis, not simplified algorithms, is the most reliable method for teaching dermoscopy for melanoma diagnosis to residents in dermatology. British Journal of Dermatology 2003;148(5):981‐4. [ER4:15465890; PUBMED: 12786829] - PubMed
Carli 2003b {published data only}
    1. Carli P, Giorgi V, Chiarugi A, Nardini P, Mannone F, Stante M, et al. Effect of lesion size on the diagnostic performance of dermoscopy in melanoma detection. Dermatology 2003;206(4):292‐6. [ER4:15465883; PUBMED: 12771468] - PubMed
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    1. Carrera C, Marchetti MA, Dusza SW, Argenziano G, Braun RP, Halpern AC, et al. Validity and reliability of dermoscopic criteria used to differentiate nevi from melanoma a web‐based international dermoscopy society study. JAMA Dermatology 2016;152(7):798‐806. [ER4:25233595; PUBMED: 27074267] - PMC - PubMed
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    1. Coras B, Glaessl A, Kinateder J, Klovekorn W, Braun R, Lepski U, et al. Teledermatoscopy in daily routine‐‐results of the first 100 cases. Current Problems in Dermatology 2003;32:207‐12. [PUBMED: 12472014] - PubMed
Cristofolini 1994 {published data only}
    1. Cristofolini M, Zumiani G, Bauer P, Cristofolini P, Boi S, Micciolo R. Dermatoscopy: usefulness in the differential diagnosis of cutaneous pigmentary lesions. Melanoma Research 1994;4(6):391‐4. [ER4:15465898; PUBMED: 7703719] - PubMed
Dal Pozzo 1999 {published data only}
    1. Dal Pozzo V, Benelli C, Roscetti E. The seven features for melanoma: a new dermoscopic algorithm for the diagnosis of malignant melanoma. European Journal of Dermatology 1999;9(4):303‐8. [ER4:18375041; PUBMED: 10356410] - PubMed
di Meo 2016 {published data only}
    1. Meo N, Stinco G, Bonin S, Gatti A, Trevisini S, Damiani G, et al. CASH algorithm versus 3‐point checklist and its modified version in evaluation of melanocytic pigmented skin lesions: the 4‐point checklist. Journal of Dermatology 2016;43(6):682‐5. [ER4:25012343; PUBMED: 26589251] - PubMed
Dolianitis 2005 {published data only}
    1. Dolianitis C, Kelly J, Wolfe R, Simpson P. Comparative performance of 4 dermoscopic algorithms by nonexperts for the diagnosis of melanocytic lesions. Archives of Dermatology 2005;141(8):1008‐14. [ER4:15465906; PUBMED: 16103330] - PubMed
Dreiseitl 2009 {published data only}
    1. Dreiseitl S, Binder M, Hable K, Kittler H. Computer versus human diagnosis of melanoma: evaluation of the feasibility of an automated diagnostic system in a prospective clinical trial. Melanoma Research 2009;19(3):180‐4. [ER4:15465907; PUBMED: 19369900] - PubMed
Duff 2001 {published data only}
    1. Duff CG, Melsom D, Rigby HS, Kenealy JM, Townsend PL. A 6 year prospective analysis of the diagnosis of malignant melanoma in a pigmented‐lesion clinic: even the experts miss malignant melanomas, but not often. British Journal of Plastic Surgery 2001;54(4):317‐21. [DOI: ; ER4:20569450; PUBMED: 11355986] - PubMed
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Durdu 2011 {published data only}
    1. Durdu M, Baba M, Seckin D. Dermatoscopy versus Tzanck smear test: a comparison of the value of two tests in the diagnosis of pigmented skin lesions. Journal of the American Academy of Dermatology 2011;65(5):972‐82. [ER4:15465910; PUBMED: 21565420] - PubMed
Feci 2015 {published data only}
    1. Feci L, Cevenini G, Nami N, Fagiolini A, Perotti R, Miracco C, et al. Influence of ambient stressors and time constraints on diagnostic accuracy of borderline pigmented skin lesions. Dermatology 2015;231(3):269‐73. [ER4:25012339; PUBMED: 26375805] - PubMed
Feldmann 1998 {published data only}
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Ferrari 2015 {published data only}
    1. Ferrari B, Pupelli G, Farnetani F, Carvalho NT, Longo C, Reggiani C, et al. Dermoscopic difficult lesions: an objective evaluation of reflectance confocal microscopy impact for accurate diagnosis. Journal of the European Academy of Dermatology and Venereology 2015;29(6):1135‐40. [DOI: 10.1111/jdv.12769; ER4:20569458; PUBMED: 25303304] - DOI - PubMed
Ferris 2015 {published data only}
    1. Ferris LK, Harkes JA, Gilbert B, Winger DG, Golubets K, Akilov O, et al. Computer‐aided classification of melanocytic lesions using dermoscopic images. Journal of the American Academy of Dermatology 2015;73(5):769‐76. [ER4:25012337; PUBMED: 26386631] - PubMed
Friedman 2008 {published data only}
    1. Friedman RJ, Gutkowicz‐Krusin D, Farber MJ, Warycha M, Schneider‐Kels L, Papastathis N, et al. The diagnostic performance of expert dermoscopists vs a computer‐vision system on small‐diameter melanomas. Archives of Dermatology 2008;144(4):476‐82. [ER4:15465921; PUBMED: 18427041] - PubMed
Gereli 2010 {published data only}
    1. Gereli MC, Onsun N, Atilganoglu U, Demirkesen C. Comparison of two dermoscopic techniques in the diagnosis of clinically atypical pigmented skin lesions and melanoma: seven‐point and three‐point checklists. International Journal of Dermatology 2010;49(1):33‐8. [ER4:15465929; PUBMED: 20465608] - PubMed
Gilmore 2010 {published data only}
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Glud 2009 {published data only}
    1. Glud M, Gniadecki R, Drzewiecki KT. Spectrophotometric intracutaneous analysis versus dermoscopy for the diagnosis of pigmented skin lesions: prospective, double‐blind study in a secondary reference centre. Melanoma Research 2009;19(3):176‐9. [ER4:18375045; PUBMED: 19319002] - PubMed
Gokdemir 2011 {published data only}
    1. Gokdemir A, Guler OM, Bek Y, Aydin F, Senturk N, Canturk T, et al. Dermoscopic and histopathological correlation in melanocytic and non‐melanocytic lesions [Melanositik ve non‐melanositik lezyonlarda dermoskopik ve histopatolojik tani korelasyonu]. Turkiye Klinikleri Dermatoloji 2011;21(1):7‐16. [EMBASE: 361807346; ER4:18375084]
Grimaldi 2009 {published data only}
    1. Grimaldi L, Silvestri A, Brandi C, Nisi G, Brafa A, Calabro M, et al. Digital epiluminescence dermoscopy for pigmented cutaneous lesions, primary care physicians, and telediagnosis: a useful tool?. Journal of Plastic, Reconstructive & Aesthetic Surgery 2009;62(8):1054‐8. [ER4:15465940; PUBMED: 18547883] - PubMed
Guitera 2009a (Modena) {published data only}
    1. Guitera P, Pellacani G, Longo C, Seidenari S, Avramidis M, Menzies SW. In vivo reflectance confocal microscopy enhances secondary evaluation of melanocytic lesions. Journal of Investigative Dermatology 2009;129(1):131‐8. [PUBMED: 18633444] - PubMed
Guitera 2009b (Sydney) {published data only}
    1. Guitera P, Pellacani G, Longo C, Seidenari S, Avramidis M, Menzies SW. In vivo reflectance confocal microscopy enhances secondary evaluation of melanocytic lesions. Journal of Investigative Dermatology 2009;129(1):131‐8. [ER4:15465945; PUBMED: 18633444] - PubMed
Haenssle 2010a (FV) {published data only}
    1. Haenssle HA, Korpas B, Hansen‐Hagge C, Buhl T, Kaune KM, Rosenberger A, et al. Seven‐point checklist for dermatoscopy: performance during 10 years of prospective surveillance of patients at increased melanoma risk. Journal of the American Academy of Dermatology 2010;62(5):785‐93. [PUBMED: 20226567] - PubMed
Haenssle 2010b (FU) {published data only}
    1. Haenssle HA, Korpas B, Hansen‐Hagge C, Buhl T, Kaune KM, Rosenberger A, et al. Seven‐point checklist for dermatoscopy: performance during 10 years of prospective surveillance of patients at increased melanoma risk. Journal of the American Academy of Dermatology 2010;62(5):785‐93. [PUBMED: 20226567] - PubMed
Hauschild 2014 {published data only}
    1. Hauschild A, Chen SC, Weichenthal M, Blum A, King HC, Goldsmith J, et al. To excise or not: impact of MelaFind on German dermatologists' decisions to biopsy atypical lesions. Journal der Deutschen Dermatologischen Gesellschaft 2014;12(7):606‐14. [ER4:17941085; PUBMED: 24944011] - PubMed
Kittler 1998 {published data only}
    1. Kittler H, Seltenheim M, Pehamberger H, Wolff K, Binder M. Diagnostic informativeness of compressed digital epiluminescence microscopy images of pigmented skin lesions compared with photographs. Melanoma Research 1998;8(3):255‐60. [ER4:17941060; PUBMED: 9664147] - PubMed
Kittler 1999 {published data only}
    1. Kittler H, Seltenheim M, Dawid M, Pehamberger H, Wolff K, Binder M. Morphologic changes of pigmented skin lesions: a useful extension of the ABCD rule for dermatoscopy. Journal of the American Academy of Dermatology 1999;40(4):558‐62. [ER4:15465976; PUBMED: 10188673] - PubMed
Kittler 2001 {published data only}
    1. Kittler H, Binder M. Risks and benefits of sequential imaging of melanocytic skin lesions in patients with multiple atypical nevi. Archives of Dermatology 2001;137(12):1590‐5. [ER4:20569472; PUBMED: 11735709] - PubMed
Krahn 1998 {published data only}
    1. Krahn G, Gottlober P, Sander C, Peter RU. Dermatoscopy and high frequency sonography: two useful non‐invasive methods to increase preoperative diagnostic accuracy in pigmented skin lesions. Pigment Cell Research 1998;11(3):151‐4. [ER4:15465981; PUBMED: 9730322] - PubMed
Kreusch 1992 {published data only}
    1. Kreusch J, Rassner G, Trahn C, Pietsch‐Breitfeld B, Henke D, Selbmann HK. Epiluminescent microscopy: a score of morphological features to identify malignant melanoma. Pigment Cell Research 1992;Suppl 2:295‐8. [PUBMED: 1409432] - PubMed
Langley 2007 {published data only}
    1. Langley RG, Walsh N, Sutherland AE, Propperova I, Delaney L, Morris SF, et al. The diagnostic accuracy of in vivo confocal scanning laser microscopy compared to dermoscopy of benign and malignant melanocytic lesions: a prospective study. Dermatology 2007;215(4):365‐72. [ER4:15465985; PUBMED: 17912001] - PubMed
Lorentzen 1999a {published data only}
    1. Lorentzen H, Weismann K, Petersen CS, Larsen FG, Secher L, Skodt V. Clinical and dermatoscopic diagnosis of malignant melanoma. Assessed by expert and non‐expert groups. Acta Dermato‐Venereologica 1999;79(4):301‐4. [ER4:17941062; PUBMED: 10429989] - PubMed
Lorentzen 2000 {published data only}
    1. Lorentzen H, Weismann K, Kenet RO, Secher L, Larsen FG. Comparison of dermatoscopic ABCD rule and risk stratification in the diagnosis of malignant melanoma. Acta Dermato‐Venereologica 2000;80(2):122‐6. [ER4:17941061; PUBMED: 10877133] - PubMed
Lorentzen 2008 {published data only}
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Malvehy 2014 {published data only}
    1. Malvehy J, Hauschild A, Curiel‐Lewandrowski C, Mohr P, Hofmann‐Wellenhof R, Motley R, et al. Clinical performance of the Nevisense system in cutaneous melanoma detection: an international, multicentre, prospective and blinded clinical trial on efficacy and safety. British Journal of Dermatology 2014;171(5):1099‐107. [PUBMED: 24841846] - PMC - PubMed
Menzies 1996 {published data only}
    1. Menzies SW, Ingvar C, Crotty KA, McCarthy WH. Frequency and morphologic characteristics of invasive melanomas lacking specific surface microscopic features. Archives of Dermatology 1996;132(10):1178‐82. [ER4:21450627; PUBMED: 8859028] - PubMed
Menzies 2005 {published data only}
    1. Menzies SW, Bischof L, Talbot H, Gutenev A, Avramidis M, Wong L, et al. The performance of SolarScan: an automated dermoscopy image analysis instrument for the diagnosis of primary melanoma. Archives of Dermatology 2005;141(11):1388‐96. [ER4:20569478; PUBMED: 16301386] - PubMed
Menzies 2008 {published data only}
    1. Menzies SW, Kreusch J, Byth K, Pizzichetta MA, Marghoob A, Braun R, et al. Dermoscopic evaluation of amelanotic and hypomelanotic melanoma. Archives of Dermatology 2008;144(9):1120‐7. [PUBMED: 18794455] - PubMed
Menzies 2009 {published data only}
    1. Menzies SW, Emery J, Staples M, Davies S, McAvoy B, Fletcher J, et al. Impact of dermoscopy and short‐term sequential digital dermoscopy imaging for the management of pigmented lesions in primary care: a sequential intervention trial. British Journal of Dermatology 2009;161(6):1270‐7. [DOI: 10.1111/j.1365-2133.2009.09374.x; ER4:15466005; PUBMED: 19747359] - DOI - PubMed
Menzies 2013 {published data only}
    1. Menzies SW, Moloney FJ, Byth K, Avramidis M, Argenziano G, Zalaudek I, et al. Dermoscopic evaluation of nodular melanoma. JAMA Dermatology 2013;149(6):699‐709. [PUBMED: 23553375] - PubMed
Morales Callaghan 2008 {published data only}
    1. Morales‐Callaghan AM, Castrodeza‐Sanz J, Martinez‐Garcia G, Peral‐Martinez I, Miranda‐Romero A. Correlation between clinical, dermatoscopic, and histopathologic variables in atypical melanocytic nevi. Actas Dermo‐Sifiliograficas 2008;99(5):380‐9. [ER4:17941068; PUBMED: 18501170] - PubMed
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    1. Nachbar F, Stolz W, Merkle T, Cognetta AB, Vogt T, Landthaler M, et al. The ABCD rule of dermatoscopy. High prospective value in the diagnosis of doubtful melanocytic skin lesions. Journal of the American Academy of Dermatology 1994;30(4):551‐9. [ER4:15466022; PUBMED: 8157780] - PubMed
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Pagnanelli 2003 {published data only}
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Piccolo 2000 {published data only}
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Piccolo 2002a {published data only}
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Piccolo 2014 {published data only}
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Pizzichetta 2002 {published data only}
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Pizzichetta 2004 {published data only}
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Pupelli 2013 {published data only}
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    1. Rubegni P, Tognetti L, Argenziano G, Nami N, Brancaccio G, Cinotti E, et al. A risk scoring system for the differentiation between melanoma with regression and regressing nevi. Journal of Dermatological Science 2016;83(2):138‐44. [ER4:25012293; PUBMED: 27157925] - PubMed
Sboner 2004 {published data only}
    1. Sboner A, Bauer P, Zumiani G, Eccher C, Blanzieri E, Forti S, et al. Clinical validation of an automated system for supporting the early diagnosis of melanoma. Skin Research & Technology 2004;10(3):184‐92. [ER4:15466104; PUBMED: 15225269] - PubMed
Seidenari 1998 {published data only}
    1. Seidenari S, Pellacani G, Pepe P. Digital videomicroscopy improves diagnostic accuracy for melanoma. Journal of the American Academy of Dermatology 1998;39(2 Pt 1):175‐81. [ER4:15466116; PUBMED: 9704824] - PubMed
Seidenari 2005 {published data only}
    1. Seidenari S, Pellacani G, Martella A. Acquired melanocytic lesions and the decision to excise: role of color variegation and distribution as assessed by dermoscopy. Dermatologic Surgery 2005;31(2):184‐9. [ER4:15466115; PUBMED: 15762212] - PubMed
Seidenari 2007 {published data only}
    1. Seidenari S, Grana C, Pellacani G. Colour clusters for computer diagnosis of melanocytic lesions. Dermatology 2007;214(2):137‐43. [ER4:15466111; PUBMED: 17341863] - PubMed
Skvara 2005 {published data only}
    1. Skvara H, Teban L, Fiebiger M, Binder M, Kittler H. Limitations of dermoscopy in the recognition of melanoma. Archives of Dermatology 2005;141(2):155‐60. [ER4:20569495; PUBMED: 15724011] - PubMed
Soyer 1995 {published data only}
    1. Soyer HP, Smolle J, Leitinger G, Rieger E, Kerl H. Diagnostic reliability of dermoscopic criteria for detecting malignant melanoma. Dermatology 1995;190(1):25‐30. [ER4:18375054; PUBMED: 7894091] - PubMed
Soyer 2004 {published data only}
    1. Soyer HP, Argenziano G, Zalaudek I, Corona R, Sera F, Talamini R, et al. Three‐point checklist of dermoscopy. A new screening method for early detection of melanoma. Dermatology 2004;208(1):27‐31. [ER4:15466124; PUBMED: 14730233] - PubMed
Stanganelli 1998a {published data only}
    1. Stanganelli I, Serafini M, Cainelli T, Cristofolini M, Baldassari L, Staffa M, et al. Accuracy of epiluminescence microscopy among practical dermatologists: a study from the Emilia‐Romagna region of Italy. Tumori 1998;84(6):701‐5. [ER4:18375055; PUBMED: 10080681] - PubMed
Stanganelli 1999 {published data only}
    1. Stanganelli I, Seidenari S, Serafini M, Pellacani G, Bucchi L. Diagnosis of pigmented skin lesions by epiluminescence microscopy: determinants of accuracy improvement in a nationwide training programme for practical dermatologists. Public Health 1999;113(5):237‐42. [ER4:15466128; PUBMED: 10557118] - PubMed
Stanganelli 2000 {published data only}
    1. Stanganelli I, Serafini M, Bucch L. A cancer‐registry‐assisted evaluation of the accuracy of digital epiluminescence microscopy associated with clinical examination of pigmented skin lesions. Dermatology 2000;200(1):11‐6. [ER4:15466129; PUBMED: 10681607] - PubMed
Stanganelli 2005 {published data only}
    1. Stanganelli I, Brucale A, Calori L, Gori R, Lovato A, Magi S, et al. Computer‐aided diagnosis of melanocytic lesions. Anticancer Research 2005;25(6C):4577‐82. [ER4:15466126; PUBMED: 16334145] - PubMed
Stanganelli 2015 {published data only}
    1. Stanganelli I, Longo C, Mazzoni L, Magi S, Medri M, Lanzanova G, et al. Integration of reflectance confocal microscopy in sequential dermoscopy follow‐up improves melanoma detection accuracy. British Journal of Dermatology 2015;172(2):365‐71. [ER4:20569496; PUBMED: 25154446] - PubMed
Stolz 1994a {published data only}
    1. Stolz W, Riemann A, Cognetta AB, Pillet L, Abmayer W, Holzel D, et al. ABCD rule of dermatoscopy: a new practical method for early recognition of malignant melanoma. European Journal of Dermatology 1994;4(7):521‐7. [EMBASE: 24349113; ER4:18375098]
Tan 2009 {published data only}
    1. Tan E, Levell NJ. Regular clinical dermatoscope use with training improves melanoma diagnosis by dermatologists. Clinical & Experimental Dermatology 2009;34(8):e876‐8. [ER4:17941000; PUBMED: 20055853] - PubMed
Tenenhaus 2010 {published data only}
    1. Tenenhaus A, Nkengne A, Horn JF, Serruys C, Giron A, Fertil B. Detection of melanoma from dermoscopic images of naevi acquired under uncontrolled conditions. Skin Research & Technology 2010;16(1):85‐97. [ER4:17941001; PUBMED: 20384887] - PubMed
Troyanova 2003 {published data only}
    1. Troyanova P. A beneficial effect of a short‐term formal training course in epiluminescence microscopy on the diagnostic performance of dermatologists about cutaneous malignant melanoma. Skin Research & Technology 2003;9(3):269‐73. [ER4:17941004; PUBMED: 12877690] - PubMed
Unlu 2014 {published data only}
    1. Unlu E, Akay BN, Erdem C. Comparison of dermatoscopic diagnostic algorithms based on calculation: the ABCD rule of dermatoscopy, the seven‐point checklist, the three‐point checklist and the CASH algorithm in dermatoscopic evaluation of melanocytic lesions. Journal of Dermatology 2014;41(7):598‐603. [ER4:15466145; PUBMED: 24807635] - PubMed
Viglizzo 2004 {published data only}
    1. Viglizzo G, Rongioletti F. Clinical, dermoscopic and pathologic correlation of pigmentary lesions observed in a dermoscopy service in the year 2003 [Correlazione clinico‐dermoscopico‐patologica delle lesioni cutanee pigmentate osservate in un servizio di dermoscopia nell'anno 2003]. Giornale Italiano di Dermatologia e Venereologia 2004;139:339‐44. [EMBASE: 39456561; ER4:18375099]
Wells 2012 {published data only}
    1. Wells R, Gutkowicz‐Krusin D, Veledar E, Toledano A, Chen SC. Comparison of diagnostic and management sensitivity to melanoma between dermatologists and MelaFind: a pilot study. Archives of Dermatology 2012;148(9):1083‐4. [ER4:15466163; PUBMED: 22986873] - PubMed
Westerhoff 2000 {published data only}
    1. Westerhoff K, McCarthy WH, Menzies SW. Increase in the sensitivity for melanoma diagnosis by primary care physicians using skin surface microscopy. British Journal of Dermatology 2000;143(5):1016‐20. [ER4:15466164; PUBMED: 11069512] - PubMed
Winkelmann 2016 {published data only}
    1. Winkelmann RR, Farberg AS, Tucker N, White R, Rigel DS. Enhancement of international dermatologists' pigmented skin lesion biopsy decisions following dermoscopy with subsequent integration of multispectral digital skin lesion analysis. Journal of Clinical and Aesthetic Dermatology 2016;9(7):53‐5. [ER4:25701735; PUBMED: 27672411] - PMC - PubMed
Zalaudek 2006 {published data only}
    1. Zalaudek I, Argenziano G, Soyer HP, Corona R, Sera F, Blum A, et al. Three‐point checklist of dermoscopy: an open internet study. British Journal of Dermatology 2006;154(3):431‐7. [ER4:15466171; PUBMED: 16445771] - PubMed

References to studies excluded from this review

Ahnlide 2013 {published data only}
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Akasu 1996 {published data only}
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Antoszewski 2015 {published data only}
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Argenziano 1999 {published data only}
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Argenziano 2002 {published data only}
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Argenziano 2003 {published data only}
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Argenziano 2004a {published data only}
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Argenziano 2004b {published data only}
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Argenziano 2008 {published data only}
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Argenziano 2010 {published data only}
    1. Argenziano G, Kittler H, Ferrara G, Rubegni P, Malvehy J, Puig S, et al. Slow‐growing melanoma: a dermoscopy follow‐up study. British Journal of Dermatology 2010;162(2):267‐73. - PubMed
Argenziano 2011a {published data only}
    1. Argenziano G, Catricala C, Ardigo M, Buccini P, Simone P, Eibenschutz L, et al. Dermoscopy of patients with multiple nevi: improved management recommendations using a comparative diagnostic approach. Archives of Dermatology 2011;147(1):46‐9. - PubMed
Argenziano 2011b {published data only}
    1. Argenziano G, Longo C, Cameron A, Cavicchini S, Gourhant J Y, Lallas A, et al. Blue‐black rule: a simple dermoscopic clue to recognize pigmented nodular melanoma. British Journal of Dermatology 2011;165(6):1251‐5. - PubMed
Argenziano 2012 {published data only}
    1. Argenziano G, Zalaudek I, Hofmann‐Wellenhof R, Bakos RM, Bergman W, Blum A, et al. Total body skin examination for skin cancer screening in patients with focused symptoms. Journal of the American Academy of Dermatology 2012;66(2):212‐9. - PubMed
Armstrong 2011 {published data only}
    1. Armstrong A. Dermoscopy: an evidence‐based approach for the early detection of melanoma. UNF Graduate Theses and Dissertations. digitalcommons.unf.edu/etd/302 (accessed prior to 16 October 2018).
Ascierto 1998 {published data only}
    1. Ascierto PA, Satriano RA, Palmieri G, Parasole R, Bosco L, Castello G. Epiluminescence microscopy as a useful approach in the early diagnosis of cutaneous malignant melanoma. Melanoma Research 1998;8(6):529‐37. - PubMed
Ascierto 2000 {published data only}
    1. Ascierto PA, Palmieri G, Celentano E, Parasole R, Caraco C, Daponte A, et al. Sensitivity and specificity of epiluminescence microscopy: evaluation on a sample of 2731 excised cutaneous pigmented lesions. The Melanoma Cooperative Study. British Journal of Dermatology 2000;142(5):893‐8. - PubMed
Ascierto 2003 {published data only}
    1. Ascierto PA, Palmieri G, Botti G, Satriano RA, Stanganelli I, Bono R, et al. Early diagnosis of malignant melanoma: proposal of a working formulation for the management of cutaneous pigmented lesions from the Melanoma Cooperative Group. International Journal of Oncology 2003;22(6):1209‐15. - PubMed
Bafounta 2001 {published data only}
    1. Bafounta ML, Beauchet A, Aegerter P, Saiag P. Is dermoscopy (epiluminescence microscopy) useful for the diagnosis of melanoma? Results of a meta‐analysis using techniques adapted to the evaluation of diagnostic tests. Archives of Dermatology 2001;137(10):1343‐50. - PubMed
Bajaj 2016 {published data only}
    1. Bajaj S, Marchetti MA, Navarrete‐Dechent C, Dusza SW, Kose K, Marghoob AA. The role of color and morphologic characteristics in dermoscopic diagnosis. JAMA Dermatology 2016;152(6):676‐82. - PMC - PubMed
Bauer 2005 {published data only}
    1. Bauer J, Blum A, Strohhacker U, Garbe C. Surveillance of patients at high risk for cutaneous malignant melanoma using digital dermoscopy. British Journal of Dermatology 2005;152(1):87‐92. - PubMed
Bauer 2006 {published data only}
    1. Bauer J, Leinweber B, Metzler G, Blum A, Hofmann‐Wellenhof R, Leitz N, et al. Correlation with digital dermoscopic images can help dermatopathologists to diagnose equivocal skin tumours. British Journal of Dermatology 2006;155(3):546‐51. - PubMed
Benati 2015 {published data only}
    1. Benati E, Argenziano G, Kyrgidis A, Moscarella E, Ciardo S, Bassoli S, et al. Melanoma and naevi with a globular pattern: confocal microscopy as an aid for diagnostic differentiation. British Journal of Dermatology 2015;173(5):1232‐8. - PubMed
Benelli 2000b {published data only}
    1. Benelli C, Roscetti E, Dal Pozzo V. Reproducibility of a dermoscopic method (7FFM) for the diagnosis of malignant melanoma. European Journal of Dermatology 2000;10(2):110‐4. - PubMed
Benvenuto‐Andrade 2006 {published data only}
    1. Benvenuto‐Andrade C, Dusza SW, Hay JL, Agero AL, Halpern AC, Kopf AW, et al. Level of confidence in diagnosis: clinical examination versus dermoscopy examination. Dermatologic Surgery 2006;32(5):738‐44. - PubMed
Benvenuto‐Andrade 2007 {published data only}
    1. Benvenuto‐Andrade C, Dusza SW, Agero AL, Scope A, Rajadhyaksha M, Halpern AC, et al. Differences between polarized light dermoscopy and immersion contact dermoscopy for the evaluation of skin lesions. Archives of Dermatology 2007;143(3):329‐38. - PubMed
Binder 1997 {published data only}
    1. Binder M, Puespoeck‐Schwarz M, Steiner A, Kittler H, Muellner M, Wolff K, et al. Epiluminescence microscopy of small pigmented skin lesions: short‐term formal training improves the diagnostic performance of dermatologists. Journal of the American Academy of Dermatology 1997;36(2 Pt 1):197‐202. - PubMed
Blum 2003c {published data only}
    1. Blum A. Amelanotic/hypomelanotic melanoma‐‐is dermatoscopy useful for diagnosis?. Journal der Deutschen Dermatologischen Gesellschaft 2003;1(8):666‐7. - PubMed
Blum 2004c {published data only}
    1. Blum A. Pattern analysis, not simplified algorithms, is the most reliable method for teaching dermoscopy for melanoma diagnosis to residents in dermatology. British Journal of Dermatology 2004;151(2):511‐2. - PubMed
Blum 2004d {published data only}
    1. Blum A, Clemens J, Argenziano G. Three‐colour test in dermoscopy: a re‐evaluation. British Journal of Dermatology 2004;150(5):1040. - PubMed
Blum 2004e {published data only}
    1. Blum A, Hofmann‐Wellenhof R. Simplified dermoscopic diagnosis of acral melanocytic lesions: mountains and valleys. Australasian Journal of Dermatology 2004;45(4):235‐6. - PubMed
Blum 2006 {published data only}
    1. Blum A, Clemens J, Argenziano G. Modified dermoscopic algorithm for the differentiation between melanocytic and nonmelanocytic skin tumors. Journal of Cutaneous Medicine & Surgery 2006;10(2):73‐8. - PubMed
Blum 2011 {published data only}
    1. Blum A, Simionescu O, Argenziano G, Braun R, Cabo H, Eichhorn A, et al. Dermoscopy of pigmented lesions of the mucosa and the mucocutaneous junction: results of a multicenter study by the International Dermoscopy Society (IDS). Archives of Dermatology 2011;147(10):1181‐7. - PubMed
Blum 2014 {published data only}
    1. Blum A, Ellwanger U, Luedtke H. Features Amplifying Dermoscopy (FAD) for better evaluation in difficult pigmented and non‐pigmented melanocytic skin tumors. Journal der Deutschen Dermatologischen Gesellschaft 2014;12(1):77‐9. - PubMed
Boespflug 2015 {published data only}
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Bono 2001 {published data only}
    1. Bono A, Maurichi A, Moglia D, Camerini T, Tragni G, Lualdi M, et al. Clinical and dermatoscopic diagnosis of early amelanotic melanoma. Melanoma Research 2001;11(5):491‐4. - PubMed
Borsari 2010 {published data only}
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Bowns 2006 {published data only}
    1. Bowns IR, Collins K, Walters SJ, McDonagh AJG. Telemedicine in dermatology: a randomised controlled trial. Health Technology Assessment (Winchester, England) 2006;10(43):iii‐iv, ix‐xi, 1‐39. - PubMed
Braun 2000 {published data only}
    1. Braun RP, Krischer J, Saurat JH. The "wobble sign" in epiluminescence microscopy as a novel clue to the differential diagnosis of pigmented skin lesions. Archives of Dermatology 2000;136(7):940‐2. - PubMed
Braun 2007 {published data only}
    1. Braun RP, Gaide O, Oliviero M, Kopf AW, French LE, Saurat JH, et al. The significance of multiple blue‐grey dots (granularity) for the dermoscopic diagnosis of melanoma. British Journal of Dermatology 2007;157(5):907‐13. - PubMed
Braun‐Falco 1990 {published data only}
    1. Braun‐Falco O, Stolz W, Bilek P, Merkle T, Landthaler M. The dermatoscope. A simplification of epiluminescent microscopy of pigmented skin changes. Hautarzt 1990;41(3):131‐6. - PubMed
Brown 2000 {published data only}
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Buhl 2012 {published data only}
    1. Buhl T, Hansen‐Hagge C, Korpas B, Kaune KM, Haas E, Rosenberger A, et al. Integrating static and dynamic features of melanoma: the DynaMel algorithm. Journal of the American Academy of Dermatology 2012;66(1):27‐36. - PubMed
Bystryn 2003 {published data only}
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Cabrijan 2008 {published data only}
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Canpolat 2011 {published data only}
    1. Canpolat F, Akış HK, Akay BN, Erdem C. Dermoscopic Features of Acral Melanocytic Nevi [Akral Melanositik Nevüslerin Dermoskopik Özellikleri]. Archives of the Turkish Dermatology & Venerology / Turkderm 2011;45(4):193‐7.
Cardenas 2009 {published data only}
    1. Cardenas E, Sosa A, Bezaury P, Madrid JV, Reyes E, Topete RO. Usefulness of high resolution ultrasound of 17 Mhz in palpable skin lesions. An analysis of 27 patients [Utilidad del ultrasonido de alta resolucion de 17 MHz en lesiones cutaneas palpables. Analisis de 27 pacientes]. Dermatologia Revista Mexicana 2009;53(3):119‐24.
Carli 1998 {published data only}
    1. Carli P, Giorgi V, Naldi L, Dosi G. Reliability and inter‐observer agreement of dermoscopic diagnosis of melanoma and melanocytic naevi. Dermoscopy Panel. European Journal of Cancer Prevention 1998;7(5):397‐402. - PubMed
Carli 2000 {published data only}
    1. Carli P, Giorgi V, Massi D, Giannotti B. The role of pattern analysis and the ABCD rule of dermoscopy in the detection of histological atypia in melanocytic naevi. British Journal of Dermatology 2000;143(2):290‐7. - PubMed
Carli 2003c {published data only}
    1. Carli P, Mannone F, Giorgi V, Nardini P, Chiarugi A, Giannotti B. The problem of false‐positive diagnosis in melanoma screening: the impact of dermoscopy. Melanoma Research 2003;13(2):179‐82. - PubMed
Carli 2004a {published data only}
    1. Carli P, Giorgi V, Chiarugi A, Nardini P, Weinstock MA, Crocetti E, et al. Addition of dermoscopy to conventional naked‐eye examination in melanoma screening: a randomized study. Journal of the American Academy of Dermatology 2004;50(5):683‐9. - PubMed
Carli 2004b {published data only}
    1. Carli P, Giorgi V, Crocetti E, Mannone F, Massi D, Chiarugi A, et al. Improvement of malignant/benign ratio in excised melanocytic lesions in the 'dermoscopy era': a retrospective study 1997‐2001. British Journal of Dermatology 2004;150(4):687‐92. - PubMed
Carli 2005 {published data only}
    1. Carli P, Chiarugi A, Giorgi V. Examination of lesions (including dermoscopy) without contact with the patient is associated with improper management in about 30% of equivocal melanomas. Dermatologic Surgery 2005;31(2):169‐72. - PubMed
Carlos‐Ortega 2007 {published data only}
    1. Carlos‐Ortega B, Sanchez‐Alva ME, Ysita‐Morales A, Angeles‐Garay U. Correlation among simple observation and dermoscopy in the study of pigmented lesions of the skin. Revista Medica del Instituto Mexicano del Seguro Social 2007;45(6):541‐8. - PubMed
Carroll 1998 {published data only}
    1. Carroll DM, Billingsley EM, Helm KF. Diagnosing basal cell carcinoma by dermatoscopy. Journal of Cutaneous Medicine & Surgery 1998;3(2):62‐7. - PubMed
Chen 2013 {published data only}
    1. Chen LL, Liebman TN, Soriano RP, Dusza SW, Halpern AC, Marghoob AA. One‐year follow‐up of dermoscopy education on the ability of medical students to detect skin cancer. Dermatology 2013;226(3):267‐73. - PubMed
Ciudad‐Blanco 2014 {published data only}
    1. Ciudad‐Blanco C, Aviles‐Izquierdo JA, Lazaro‐Ochaita P, Suarez‐Fernandez R. Dermoscopic findings for the early detection of melanoma: an analysis of 200 cases. Actas Dermo‐Sifiliograficas 2014;105(7):683‐93. - PubMed
de Giorgi 2006 {published data only}
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De Giorgi 2011 {published data only}
    1. Giorgi V, Grazzini M, Rossari S, Gori A, Alfaioli B, Papi F, et al. Adding dermatoscopy to naked eye examination of equivocal melanocytic skin lesions: effect on intention to excise by general dermatologists. Clinical & Experimental Dermatology 2011;36:255‐9. [ER4:15465901] - PubMed
Delfino 1997 {published data only}
    1. Delfino M, Fabbrocini G, Argenziano G, Magliocchetti N, Nofroni I. A statistical analysis of the characteristics of pigmented skin lesions using epiluminescence microscopy. Journal of the European Academy of Dermatology and Venereology 1997;9(3):243‐8.
de Troya‐Martin 2008 {published data only}
    1. Troya‐Martin M, Blazquez‐Sanchez N, Fernandez‐Canedo I, Frieyro‐Elicegui M, Funez‐Liebana R, Rivas‐Ruiz F. Dermoscopic study of cutaneous malignant melanoma: descriptive analysis of 45 cases. Actas Dermo‐Sifiliograficas 2008;99(1):44‐53. - PubMed
Di Chiacchio 2010 {published data only}
    1. Chiacchio N, Hirata SH, Enokihara MY, Michalany NS, Fabbrocini G, Tosti A. Dermatologists' accuracy in early diagnosis of melanoma of the nail matrix. Archives of Dermatology 2010;146(4):382‐7. - PubMed
Di Stefani 2007 {published data only}
    1. Stefani A, Zalaudek I, Argenziano G, Chimenti S, Soyer HP. Feasibility of a two‐step teledermatologic approach for the management of patients with multiple pigmented skin lesions. Dermatologic Surgery 2007;33(6):686‐92. - PubMed
Dummer 1995 {published data only}
    1. Dummer W, Blaheta HJ, Bastian BC, Schenk T, Brocker EV, Remy W. Preoperative characterization of pigmented skin lesions by epiluminescence microscopy and high‐frequency ultrasound. Archives of Dermatology 1995;131(3):279‐85. - PubMed
Elwan 2016 {published data only}
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Fabbrocini 2008 {published data only}
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Ferrara 2002 {published data only}
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