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The Diagnostic Performance of Expert Dermoscopists vs a Computer-Vision System on Small-Diameter Melanomas
Robert J. Friedman, MD;
Dina Gutkowicz-Krusin, PhD;
Michele J. Farber;
Melanie Warycha, MD;
Lori Schneider-Kels, MPH;
Nicole Papastathis, BA;
Martin C. Mihm Jr, MD;
Paul Googe, MD;
Roy King, MD;
Victor G. Prieto, MD, PhD;
Alfred W. Kopf, MS, MD;
David Polsky, MD, PhD;
Harold Rabinovitz, MD;
Margaret Oliviero, ARNP;
Armand Cognetta, MD;
Darrell S. Rigel, MD;
Ashfaq Marghoob, MD;
Jason Rivers, MD, FRCPC;
Robert Johr, MD;
Jane M. Grant-Kels, MD;
Hensin Tsao, MD, PhD
Arch Dermatol. 2008;144(4):476-482.
Objective To evaluate the performance of dermoscopists in diagnosing small pigmented skin lesions (diameter  6 mm) compared with an automatic multispectral computer-vision system.
Design Blinded comparison study.
Setting Dermatologic hospital-based clinics and private practice offices.
Patients From a computerized skin imaging database of 990 small ( 6-mm) pigmented skin lesions, all 49 melanomas from 49 patients were included in this study. Fifty randomly selected nonmelanomas from 46 patients served as a control.
Main Outcome Measures Ten dermoscopists independently examined dermoscopic images of 99 pigmented skin lesions and decided whether they identified the lesions as melanoma and whether they would recommend biopsy to rule out melanoma. Diagnostic and biopsy sensitivity and specificity were computed and then compared with the results of the computer-vision system.
Results Dermoscopists were able to correctly identify small melanomas with an average diagnostic sensitivity of 39% and a specificity of 82% and recommended small melanomas for biopsy with a sensitivity of 71% and specificity of 49%, with only fair interobserver agreement ( = 0.31 for diagnosis and 0.34 for biopsy). In comparison, in recommending biopsy to rule out melanoma, the computer-vision system achieved 98% sensitivity and 44% specificity.
Conclusions Differentiation of small melanomas from small benign pigmented lesions challenges even expert physicians. Computer-vision systems can facilitate early detection of small melanomas and may limit the number of biopsies to rule out melanoma performed on benign lesions.
Author Affiliations: Department of Dermatology, New York University School of Medicine, New York (Drs Friedman, Warycha, Kopf, Polsky, and Rigel and Mss Farber, Schneider-Kels, and Papastathis), Electro-Optical Sciences Inc, Irvington (Dr Gutkowicz-Krusin), and Memorial Sloan-Kettering Cancer Center, New York (Dr Marghoob), New York; Departments of Dermatology (Drs Mihm and Tsao) and Dermatopathology (Dr Mihm), Massachusetts General Hospital, and Harvard Medical School (Dr Mihm), Boston, Massachusetts; Knoxville Dermatopathology Laboratory, Knoxville, Tennessee (Drs Googe and King); The University of Texas M. D. Anderson Cancer Center, Houston (Dr Prieto); Skin and Cancer Associates, Plantation (Dr Rabinovitz and Ms Oliviero), Dermatology Associates of Tallahassee, Tallahassee (Dr Cognetta), and Department of Dermatology, University of Miami School of Medicine, Miami (Dr Johr), Florida; Department of Dermatology, University of British Columbia, and General Hospital and British Columbia Cancer Agency, Vancouver (Dr Rivers); and University of Connecticut Health Center, Farmington (Dr Grant-Kels).
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