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May 2007

Dermoscopy Not Yet Shown to Increase Sensitivity of Melanoma Diagnosis in Real Practice—Reply

Arch Dermatol. 2007;143(5):659-675. doi:10.1001/archderm.143.5.665

In reply

I read with interest the comments by Carli regarding the lack of evidence for dermoscopy increasing the sensitivity for melanoma in the field. As he correctly stated, all of the evidence cited showing an increased sensitivity for the diagnosis of melanoma compares a clinical diagnosis of melanoma (yes or no) with naked-eye vs dermoscopy examination on lesions excised. It is a requirement for diagnostic devices to be contrasted with a gold standard, which in this field is histopathologic diagnosis. As admitted by Carli, there is unquestioned evidence that dermoscopy increases the correct diagnosis of histopathologically proven melanoma compared with naked-eye examination in this setting, and unless he states that the melanomas in these studies were not representative of melanomas seen in the field, we can be confident that a clinician trained in dermoscopy will correctly diagnose melanoma at a significantly higher rate (19% higher based on meta-analysis results) than with naked-eye examination alone.1 Carli, however, claims that the incorrect diagnosis seen with naked-eye examination may not equate with incorrect management, in that equivocal misclassified lesions may be excised. Hence, in the field, dermoscopy may not improve sensitivity. However, is there any evidence, theoretical or real, for this assumption?

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