Systematic review of the diagnostic accuracy of dermatoscopy in detecting malignant melanoma

Objective: To assess the evidence that dermatoscopy improves the accuracy of diagnosis of melanomas in clinical practice. Data sources: MEDLINE 1983-January 1997, EMBASE 1980-1996, and bibliographies of retrieved articles. Study selection and data extraction: Studies selected were original studies with formal methods and results sections comparing diagnostic accuracy of dermatoscopy for malignant melanoma with another clinical method; the criterion standard was excision biopsy with histopathological examination; and accuracy of dermatoscopic diagnosis was determined over a spectrum of stages of melanoma and skin lesions commonly confused with melanoma. Data were extracted by a single observer. Data synthesis: 579 articles were identified; six studies met the inclusion criteria. Positive likelihood ratios for dermatoscopy for diagnosis of melanoma ranged from 2.9 to 10.3. Dermatoscopy had 10%-27% higher sensitivity than clinical diagnosis in the two studies with the most clinically equivocal lesions. However, when sensitivity of clinical diagnosis was more than 84%, sensitivity of dermatoscopy was only slightly higher. One study of dermatologists with no training in dermatoscopy showed a significant decrease in sensitivity. Conclusions: Variability between studies in methods, observers and types of pigmented skin lesions and lack of studies in primary care make generalisation of results difficult. Dermatoscopy appeared not to improve the accuracy of diagnosis enough to alter the clinical management of most pigmented skin lesions. Further research with more explicit methods is needed.