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Dermoscopy of pigmented skin lesions: Results of a consensus meeting via the Internet,☆☆,,★★

A case-by-case summary of data from all colleagues taking part of this virtual study is presented in an atlas called Dermoscopy of Pigmented Skin Lesions: An Atlas Based on the Consensus Net Meeting on Dermoscopy 2000. Milan, Italy: Edra Medical Publishing and New Media; 2001.
https://doi.org/10.1067/mjd.2003.281Get rights and content

Abstract

Background: There is a need for better standardization of the dermoscopic terminology in assessing pigmented skin lesions. Objective: The virtual Consensus Net Meeting on Dermoscopy was organized to investigate reproducibility and validity of the various features and diagnostic algorithms. Methods: Dermoscopic images of 108 lesions were evaluated via the Internet by 40 experienced dermoscopists using a 2-step diagnostic procedure. The first-step algorithm distinguished melanocytic versus nonmelanocytic lesions. The second step in the diagnostic procedure used 4 algorithms (pattern analysis, ABCD rule, Menzies method, and 7-point checklist) to distinguish melanoma versus benign melanocytic lesions. κ Values, log odds ratios, sensitivity, specificity, and positive likelihood ratios were estimated for all diagnostic algorithms and dermoscopic features. Results: Interobserver agreement was fair to good for all diagnostic methods, but it was poor for the majority of dermoscopic criteria. Intraobserver agreement was good to excellent for all algorithms and features considered. Pattern analysis allowed the best diagnostic performance (positive likelihood ratio: 5.1), whereas alternative algorithms revealed comparable sensitivity but less specificity. Interobserver agreement on management decisions made by dermoscopy was fairly good (mean κ value: 0.53). Conclusion: The virtual Consensus Net Meeting on Dermoscopy represents a valid tool for better standardization of the dermoscopic terminology and, moreover, opens up a new territory for diagnosing and managing pigmented skin lesions. (J Am Acad Dermatol 2003;48:679-93.)

J Am Acad Dermatol 2003;48:679-93.

Section snippets

Selection of participants and dermoscopic criteria

In all, 51 experienced clinicians in the field of dermoscopy were invited to participate in the CNMD. The selection for invitation was on the basis of the experience of the colleagues in dermoscopy, as demonstrated by publications and lectures on the topic. Colleagues from many different countries were invited to get a consensus panel with a broad geographic distribution.

The preliminary scientific design, including the list of selected criteria and diagnostic methods to be evaluated, was

Results

In all, 51 experienced clinicians in the field of dermoscopy were invited to participate in the CNMD, and 40 actively participated in this study. Geographic distribution of the participating board members is as follows: 24 participants from Europe (9 countries); 11 from the United States; and 5 from the rest of the world (2 participants from Japan, and 1 each from Argentina, Australia, and Mexico). In response to the initial questionnaire, 21 of the 40 participants selected pattern analysis as

Discussion

For the CNMD, 40 experienced clinicians from 14 countries worldwide convened virtually over a 4-month period to redefine the dermoscopic terminology and to examine the various algorithmic methods for differentiating melanoma from benign melanocytic lesions. The CNMD convened via the World Wide Web at the domain www.dermoscopy.org from July to November 2000. To our knowledge the CNMD was the first consensus meeting using the Internet within the dermatologic community. The clinical and

Acknowledgements

We are very grateful to Barbara J. Rutledge, PhD, for critical review and editing assistance. Gianluigi Visco was responsible for the World Wide Web design and technical support, and we are extremely grateful to him. Particular thanks goes to Vincenzo Coluccia, who originally envisioned this World Wide Web-based consensus meeting.

References (35)

  • HP Soyer et al.

    Surface microscopy: a new approach to the diagnosis of cutaneous pigmented tumors

    Am J Dermatopathol

    (1989)
  • J Kreusch et al.

    Standardisierte auflichtmikroskopische unterscheidung melanozytischer und nichtmelanozytischer pigmentmale

    Hautarzt

    (1991)
  • H Pehamberger et al.

    In vivo epiluminescence microscopy: improvement of early diagnosis of melanoma

    J Invest Dermatol

    (1993)
  • RO Kenet et al.

    Clinical diagnosis of pigmented lesions using digital epiluminescence microscopy: grading protocol and atlas

    Arch Dermatol

    (1993)
  • S Yadav et al.

    Histopathologic correlates of structures seen on dermoscopy (epiluminescence microscopy)

    Am J Dermatopathol

    (1993)
  • W Stolz et al.

    ABCD rule of dermatoscopy: a new practical method for early recognition of malignant melanoma

    Eur J Dermatol

    (1994)
  • T Saida et al.

    In vivo observation of magnified features of pigmented lesions on volar skin using video macroscope: usefulness of epiluminescence techniques in clinical diagnosis

    Arch Dermatol

    (1995)
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    All technical issues related to this Internet study supported by Edra Medical Publishing and New Media, Milan, Italy.

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    Conflict of interest: None identified.

    Reprint requests: H. Peter Soyer, MD, Department of Dermatology, University of Graz, Auenbruggerplatz 8 - A8036 Graz, Austria. E-mail: [email protected].

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