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  • Title: The dermoscopic inverse approach significantly improves the accuracy of human readers for lentigo maligna diagnosis.
    Author: Lallas A, Lallas K, Tschandl P, Kittler H, Apalla Z, Longo C, Argenziano G.
    Journal: J Am Acad Dermatol; 2021 Feb; 84(2):381-389. PubMed ID: 32592885.
    Abstract:
    BACKGROUND: A recently introduced dermoscopic method for the diagnosis of early lentigo maligna (LM) is based on the absence of prevalent patterns of pigmented actinic keratosis and solar lentigo/flat seborrheic keratosis. We term this the inverse approach. OBJECTIVE: To determine whether training on the inverse approach increases the diagnostic accuracy of readers compared to classic pattern analysis. METHODS: We used clinical and dermoscopic images of histopathologically diagnosed LMs, pigmented actinic keratoses, and solar lentigo/flat seborrheic keratoses. Participants in a dermoscopy masterclass classified the lesions at baseline and after training on pattern analysis and the inverse approach. We compared their diagnostic performance among the 3 timepoints and to that of a trained convolutional neural network. RESULTS: The mean sensitivity for LM without training was 51.5%; after training on pattern analysis, it increased to 56.7%; and after learning the inverse approach, it increased to 83.6%. The mean proportions of correct answers at the 3 timepoints were 62.1%, 65.5, and 78.5%. The percentages of readers outperforming the convolutional neural network were 6.4%, 15.4%, and 53.9%, respectively. LIMITATIONS: The experimental setting and the inclusion of histopathologically diagnosed lesions only. CONCLUSIONS: The inverse approach, added to the classic pattern analysis, significantly improves the sensitivity of human readers for early LM diagnosis.
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