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Accuracy and confidence in the clinical diagnosis of basal cell cancer using dermoscopy and reflex confocal microscopy
Author(s) -
Nelson Steven A.,
Scope Alon,
Rishpon Ayelet,
Rabinovitz Harold S.,
Oliviero Margaret C.,
Laman Susan D.,
Cole Christine M.,
Chang YuHui H.,
Swanson David L.
Publication year - 2016
Publication title -
international journal of dermatology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.677
H-Index - 93
eISSN - 1365-4632
pISSN - 0011-9059
DOI - 10.1111/ijd.13361
Subject(s) - medicine , biopsy , basal cell carcinoma , radiology , malignancy , confidence interval , mohs surgery , referral , dermatology , pathology , basal cell , family medicine
Background Diagnosis of suspected basal cell carcinoma ( BCC ) is typically confirmed with incisional biopsy before referral to final surgery. Objective To investigate the clinical confidence and accuracy of physicians making a diagnosis of BCC based on dermoscopic and reflectance confocal microscopy ( RCM ) features. Methods This study was designed as a simulation to determine the certainty and willingness to refer to surgery without previous biopsy confirmation of BCC . Study subjects were identified with suspected BCC . Dermoscopic and RCM lesion images were obtained before biopsy. Eight clinicians with various expertise levels blindly interpreted these images and chose among four hypothetical treatment options: definite BCC , refer directly to surgery without biopsy; other malignancy, perform biopsy for diagnosis; uncertain diagnosis, perform biopsy; benign, do not biopsy. Decisions for treatment were based on dermoscopic images alone and, subsequently, on dermoscopic and RCM images combined. Results The sensitivity for referral to surgery without biopsy was 67.6% with the use of dermoscopy; the positive predictive value (PPV) was 97.0%. Adding RCM increased the sensitivity to 76.5% and the PPV to 98.6%. Conclusions Dermoscopy provides a high PPV for BCC . The addition of RCM to dermoscopy increases diagnostic sensitivity, particularly in less experienced dermoscopists. Physician behavior might be different if actual referrals were made for surgery without biopsy.