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

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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

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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

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DISCUSSION

Primary care evaluation plays a significant role in the diagnosis and management of PSLs, ultimately shaping outcomes for patients with melanoma. Improved accuracy of PSL classification could yield greater sensitivity for the diagnosis of melanomas and high-risk melanocytic lesions at earlier stages, while also reducing the number of unnecessary biopsies and referrals—leading to decreased patient morbidity and mortality and reduced health care spending.⁹

Diagnostic tools are valuable insofar as they can improve accuracy and positively impact clinical management and patient outcomes.¹⁰ In this case, increased sensitivity reduced missed melanoma diagnoses, while increased specificity avoided the additional costs and patient toll associated with a biopsy or referral for a benign lesion.

Dermoscopy has been shown to improve the sensitivity and specificity of PSL diagnosis compared with visual inspection alone; however, without substantial training and experience, accuracy with dermoscopy can be no better than examination with the naked eye.^3,11,12 The dropout rates are high for training PCPs in its use, given that several months of training may be needed for competent use.^13,14 To improve the clinical management of PSLs broadly in primary care, a need exists for easy-to-use adjunctive tools that increase diagnostic accuracy.¹⁵

In this study, with only a brief explanation of how to interpret EIS scores, clinicians without any prior experience using EIS demonstrated significantly improved accuracy in deciding appropriate management and classifying melanocytic lesions with the addition of EIS to visual inspection. These improvements, seen in clinicians of varying training and experience, suggest that the learning curve of EIS may not be as steep as that of dermoscopy.

The greater baseline sensitivity, specificity, and diagnostic accuracy of physicians’ clinical decision-making compared with NPs before the incorporation of EIS in the study may be a product of comparatively more extensive medical training. In addition, EIS yielded a greater benefit to NPs than to physicians, with greater increases in sensitivity and specificity noted. This suggests that the use of EIS is particularly advantageous to clinicians who are less proficient in assessing melanocytic lesions. Using visual inspection alone, more experienced respondents made biopsy/referral decisions with greater sensitivity but similar specificity to those with less experience. With the incorporation of EIS scores, the sensitivity and specificity of respondents’ clinical decision-making rose to comparable levels across all experience groups, providing further indication of EIS’s particular value to clinicians who are less proficient in PSL evaluation.

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