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Soo Park, MD
Soo Park, MD
Posted: Friday, December 13, 2024
A recent systematic review and meta-analysis found significant differences in accurately diagnosing skin cancer when comparing physician specialty and experience as well as examination methods. Additionally, Maria L. Wei, MD, PhD, of the San Francisco Veterans Affairs Health Care System, and researchers observed that dermatologists had a 13.3-fold increased accuracy over primary care physicians (PCPs) when diagnosing melanoma. Overall, dermatologists were found to have the greatest accuracy in diagnosis by using both dermoscopy and clinical examination. These findings were published in JAMA Dermatology.
“These summary metrics of clinician diagnostic accuracy could be useful benchmarks for clinical trials, practitioner training, and the performance of emerging technologies,” the investigators proposed.
A total of 100 studies (case-control, randomized, and nonrandomized controlled) used in the analysis focused on dermatologists or PCPs examining keratinocytic or melanocytic skin lesions. Meta-analysis of diagnostic accuracy comprised sensitivity and specificity by physician type and experience as well as examination method (in-person clinical examination and/or clinical images vs dermoscopy and/or dermoscopic images).
Experienced dermatologists using clinical examination and clinical images had a sensitivity and specificity for diagnosing keratinocytic carcinomas of 79.0% and 89.1%, respectively; when they used dermoscopy and dermoscopic images, the sensitivity and specificity were 83.7% and 87.4%; and for PCPs, the sensitivity and specificity were 81.4% and 80.1%. Experienced dermatologists had 2.5-fold higher odds of accurate diagnosis of keratinocytic carcinomas using in-person dermoscopy and dermoscopic images compared with in-person clinical examination and images. Experienced dermatologists examining individuals for melanoma using clinical examination and images had a sensitivity and specificity at 76.9% and 89.1%; for inexperienced dermatologists, these rates were 78.3% and 66.2%; for PCPs, the sensitivity and specificity were 37.5% and 84.6%. In contrast, with dermoscopy and dermoscopic images, sensitivity and specificity were 85.7% and 81.3% for experienced dermatologists, 78.0% and 69.5% for inexperienced dermatologists, and 49.5% and 91.3% for PCPs, respectively. Experienced dermatologists had 5.7-fold higher odds of accurate diagnosis of melanoma using dermoscopy compared with clinical examination.
Disclosure: The study authors reported no conflicts of interest.
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