Cochrane systematic review of diagnostic accuracy of dermoscopy in comparison to visual inspection for the diagnosis of melanoma

Abstract

Early detection of melanoma is essential to improve survival.The additional value of dermoscopy over and above visualinspection (VI) of a suspicious skin lesion is critical to under-stand its contribution to the diagnosis of melanoma. ACochrane systematic review of the diagnostic accuracy of der-moscopy for detection of melanoma in adults was undertakenfor (i) in-person diagnosis and (ii) diagnosis based on dermo-scopic images, and to compare its accuracy with VI alone. Acomprehensive search of 10 databases up to August 2016identified studies of any design evaluating dermoscopy inadults with lesions suspicious for melanoma, compared withhistology or clinical follow-up. Two reviewers independentlyextracted data and quality assessment (using QUADAS-2). Theaccuracy was estimated using hierarchical summary ROCmethods; sensitivities and specificities were estimated forselected points on the summary receiver operating characteris-tic (SROC) curve. Overall, 106 publications were included.The detection of melanoma or intraepidermal melanocyticvariants was analysed for 27 in-person (23 487 lesions; 1737melanomas) and 60 image-based (13 475 lesions; 2851 mela-nomas) datasets. In-person dermoscopy was more accuratethan image-based interpretation [relative diagnostic odds ratio(RDOR) 4.5; 95% CI 2.3–8.5, P < 0.0001]. Dermoscopy wasmore accurate than VI alone; RDORs (i) 4.8 (95% CI: 3.1–7.4; P < 0.0001) for in-person and (ii) 5.6 (95% CI: 3.7–8.5;P < 0.0001) for image-based evaluations. Predicted increasesin sensitivity were (i) 16% (92% vs. 76%) and (ii) 34% (81%vs. 47%) at a fixed specificity of 80%. Use of a publishedalgorithm to assist dermoscopy had no significant impact onaccuracy. The accuracy was significantly higher for experi-enced observers compared with less experienced. Dermoscopyis a valuable tool to support VI of suspicious skin lesions todetect melanoma, particularly in referred populations and for