A worthwhile tool in evaluating worrisome lesions

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doi:doi: 10.12788/jfp.0655

Original Research

A worthwhile tool in evaluating worrisome lesions

J Fam Pract. 2023 September;72(7):E1-E22 | doi: 10.12788/jfp.0655

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References

1. Goetsch NJ, Hoehns JD, Sutherland JE, et al. Assessment of postgraduate skin lesion education among Iowa family physicians. SAGE Open Med. 2017;5:2050312117691392. doi: 10.1177/2050312117691392

2. Dinnes J, Deeks JJ, Chuchu N, et al. Dermoscopy, with and without visual inspection, for diagnosing melanoma in adults. Cochrane Database Syst Rev. 2018;12:CD011902. doi: 10.1002/14651858.CD011902.pub2

3. Jones OT, Jurascheck LC, van Melle MA, et al. Dermoscopy for melanoma detection and triage in primary care: a systematic review. BMJ Open. 2019;9:e027529. doi: 10.1136/bmjopen-2018-027529

4. Malvehy J, Hauschild A, Curiel-Lewandrowski C, et al. Clinical performance of the Nevisense system in cutaneous melanoma detection: an international, multicentre, prospective and blinded clinical trial on efficacy and safety. Br J Dermatol. 2014;171:1099-1107. doi: 10.1111/bjd.13121

5. Svoboda RM, Prado G, Mirsky RS, et al. Assessment of clinician accuracy for diagnosing melanoma on the basis of electrical impedance spectroscopy score plus morphology versus lesion morphology alone. J Am Acad Dermatol. 2019;80:285-287. doi: 10.1016/j.jaad.2018.08.048

6. Mohr P, Birgersson U, Berking C, et al. Electrical impedance spectroscopy as a potential adjunct diagnostic tool for cutaneous melanoma. Skin Res Technol. 2013;19:75-83. doi: 10.1111/srt.12008

7. Rocha L, Menzies SW, Lo S, et al. Analysis of an electrical impedance spectroscopy system in short-term digital dermoscopy imaging of melanocytic lesions. Br J Dermatol. 2017;177:1432-1438. doi: 10.1111/bjd.15595

8. Litchman GH, Teplitz RW, Marson JW, et al. Impact of electrical impedance spectroscopy on dermatologists’ number needed to biopsy metric and biopsy decisions for pigmented skin lesions. J Am Acad Dermatol. 2021;85:976-979. doi: 10.1016/j.jaad.2020.09.011

9. Greenwood-Lee J, Jewett L, Woodhouse L, et al. A categorisation of problems and solutions to improve patient referrals from primary to specialty care. BMC Health Serv Res. 2018;18:1-16. doi: 10.1186/s12913-018-3745-y

10. Bossuyt PM, Reitsma JB, Linnet K, et al. Beyond diagnostic accuracy: the clinical utility of diagnostic tests. Clin Chem. 2012;58:1636-1643. doi: 10.1373/clinchem.2012.182576

11. Argenziano G, Cerroni L, Zalaudek I , et al. Accuracy in melanoma detection: a 10-year multicenter survey. J Am Acad Dermatol. 2012;67:54-59. doi: 10.1016/j.jaad.2011.07.019

12. Menzies SW, Vestergaard ME, Macaskill P, et al. Dermoscopy compared with naked eye examination for the diagnosis of primary melanoma: a meta-analysis of studies performed in a clinical setting. Br J Dermatol. 2008;159:669-676. doi: 10.1111/j.1365-2133.2008.08713.x

13. Menzies SW, Emery J, Staples M, 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. Br J Dermatol. 2009;161:1270-1277. doi: 10.1111/j.1365-2133.2009.09374.x

14. Noor O, Nanda A, Rao BK. A dermoscopy survey to assess who is using it and why it is or is not being used. Int J Dermatol. 2009;48:951-952. doi: 10.1111/j.1365-4632.2009.04095.x

15. Weigl BH, Boyle DS, de los Santos T, et al. Simplicity of use: a critical feature for widespread adoption of diagnostic technologies in low-resource settings. Expert Rev Med Devices. 2009;6:461-464. doi: 10.1586/erd.09.31

16. Sarac E, Meiwes A, Eigentler T, et al. Diagnostic accuracy of electrical impedance spectroscopy in non-melanoma skin cancer. Acta Derm Venereol. 2020;100:adv00328. doi: 10.2340/00015555-3689

EIS provides high-sensitivity melanoma diagnosis vs histopathologic confirmation from biopsies, with 1 study showing a 96.6% sensitivity rating, detecting 256 of 265 melanomas.⁴ The EIS device, by measuring differences in electrical resistance between benign and cancerous cells, outputs a simple integer score ranging from 0 to 10 associated with the likelihood of the lesion being a melanoma.⁸ Based on data from the Nevisense pivotal trial,⁴ Nevisense reports that scores of 0 to 3 carry a negative predictive value of 99% for melanoma, whereas scores of 4 to 10 signify increasingly greater positive predictive values from 7% to 61%.

Findings suggest that the use of electrical impedance spectroscopy is particularly advantageous to clinicians who are less proficient in assessing melanocytic lesions.

We aimed to assess whether EIS may be beneficial to PCPs by comparing the accuracy of clinical decision-making for PSLs based on visual examination alone with that based on concurrent visual and EIS evaluation.

METHODS

A questionnaire was distributed via email to 142 clinicians at clinics affiliated with either of 2 organizations delivering care to the New York City area through a network of community health centers: the Institute for Family Health (IFH) and the Community Healthcare Network (CHN). Of these recipients, 72 were affiliated with IFH across 27 community health centers and 70 were affiliated with CHN across 14 community health centers. Recipients were physicians and nurse practitioners (NPs) practicing at primary health care facilities.

Survey instrument. The first section of the survey instrument (APPENDIX) solicited demographic information and explained how to apply the EIS scores for diagnostic decision-making. The second featured images of 12 randomly selected, histologically confirmed, and EIS-evaluated PSLs from a previously published prospective blinded trial of 2416 lesions.⁴ The Institutional Review Board of the Icahn School of Medicine at Mount Sinai reviewed and approved the study and survey instrument.

Clinical images of these lesions, comprising 4 melanocytic nevi, 4 dysplastic nevi (including 3 mild-moderately dysplastic and 1 severely dysplastic nevus), and 4 melanomas, were first presented to respondents with 2 tasks: (1) rate on a scale of 1 to 5 their likelihood to biopsy or refer this lesion to a dermatologist (1: not likely; 5: extremely likely); and (2) select what they expect the pathology results to be: melanocytic nevus, dysplastic nevus, or malignant melanoma. Subsequently, respondents repeated the assessments after being presented with the EIS score for the same lesion in conjunction with the clinical image.

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