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How accurate is visual inspection of skin lesions for diagnosis of melanoma in adults?

A systematic review published in theThe Cochrane Database of Systematic Reviewssuggests that visual inspection of melanomas alone could miss the diagnosis of melanoma in patients with suspicious skin lesions. The evidence to support its accuracy in the range of settings in which it is used is flawed and very poorly reported

Cochrane review identified 49 studies including 51 study cohorts (lesions, 34,351 lesions; patients, 2499) that evaluated visual inspection in adults with suspicious skin lesion for melanoma compared with a reference standard of either histological confirmation or clinical follow-up, after a search across electronic databases.

In-person diagnosis was associated with better accuracy compared with image-based evaluation (relative diagnostic OR, 8.54; P<.001). In meta-analysis, highest sensitivity (92.4%; 95% CI, 26.2-99.8%) and lowest specificity (79.7%; 95% CI, 73.7-84.7%) were observed in patients with limited prior testing. Lower sensitivity (76.7%; 95% CI, 61.7-87.1%) and higher specificity (95.7%; 95% CI, 89.7-98.3%) were observed in patients referred for special assessment and selected for excision.

There was no clear evidence that algorithm use improved diagnostic accuracy in in-person evaluations for no algorithm (OR, 46.2; 95% CI, 21.9-97.5) vs for various algorithms (OR between 3.24; 95% CI, 1.49-7.07 and 36.6; 95% CI, 7.94-168). Similar results were observed in image-based evaluations for no algorithm (OR, 7.47; 95% CI, 4.12-13.5) vs for Asymmetrical Shape, Border, Color, Diameter, and Evolution (ABCDE) algorithm (OR, 2.87; 95% CI, 0.93-8.79).

Authors commented, “There was considerable variation and uncertainty about the diagnostic accuracy of visual inspection checklist for the diagnosis of melanoma. No evidence suggested that visual inspection will reliably improve the diagnostic accuracy of visual inspection, so recommendations cannot be made about when they should be used.”

“Despite the existence of numerous research studies, further, well-reported studies are warranted to assess the diagnostic accuracy of visual inspection with and without visual inspection checklists and by clinicians with different levels of skills, “they further added.


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