Development of a Photographic Scale for Consistency and Guidance in Dermatologic Assessment of Forearm Sun Damage | Dermatology | JAMA Dermatology | JAMA Network
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January 17, 2011

Development of a Photographic Scale for Consistency and Guidance in Dermatologic Assessment of Forearm Sun Damage

Author Affiliations

Author Affiliations: College of Nursing (Dr McKenzie), Skin Cancer Prevention Annex (Mss Saboda, Duckett, and Goldman), Mel and Enid Zuckerman College of Public Health (Dr Hu), and College of Medicine (Dr Curiel-Lewandrowski), Arizona Cancer Center, University of Arizona, Tucson.

Arch Dermatol. 2011;147(1):31-36. doi:10.1001/archdermatol.2010.392

Objectives  To develop a photographic sun damage assessment scale for forearm skin and test its feasibility and utility for consistent classification of sun damage.

Design  For a blinded comparison, 96 standardized 8 × 10 digital photographs of participants' forearms were taken. Photographs were graded by an expert dermatologist using an existing 9-category dermatologic assessment scoring scale until all categories contained photographs representative of each of 4 clinical signs. Triplicate photographs were provided in identical image sets to 5 community dermatologists for blinded rating using the dermatologic assessment scoring scale.

Setting  Academic skin cancer prevention clinic with high-level experience in assessment of sun-damaged skin.

Participants  Volunteer sample including participants from screenings, chemoprevention, and/or biomarker studies.

Main Outcome Measures  Reproducibility and agreement of grading among dermatologists by Spearman correlation coefficient to assess the correlation of scores given for the same photograph, κ statistics for ordinal data, and variability of scoring among dermatologists, using analysis of variance models with evaluating physician and photographs as main effects and interaction effect variables to account for the difference in scoring among dermatologists.

Results  Correlations (73% to >90%) between dermatologists were all statistically significant (P < .001). Scores showed good to substantial agreement but were significantly different (P < .001) for each of 4 clinical signs and the difference varied significantly (P < .001) among photographs.

Conclusions  With good to substantial agreement, we found the development of a photographic forearm sun damage assessment scale highly feasible. In view of significantly different rating scores, a photographic reference for assessment of sun damage is also necessary.