Reevaluation of the ABCD rule for epiluminescence microscopy

Background: Epiluminescence microscopy (ELM) provides for increased accurac y in the clinical diagnosis of pigmented skin lesions (PSL). It is based on pattern analysis of ELM criteria, which requires experience. The recently introduced application of the ABCD score to ELM facilitates this by permitt ing lesion evaluation on the basis of predefined clinical criteria. Objective: The present study was performed to evaluate the diagnostic perfo rmance of the ABCD rule for ELM in pigmented skin lesions testing dermatolo gists with varying skills from novice to expert. Methods: Two hundred fifty electronic images of randomly selected, histolog ically proven PSL including 41 early melanomas (16.4%) were presented to th e raters, and each image was scored according to the rules of the ABCD scor e and rated without the guidance of a scoring system on a scale from 1 = de finitely benign to 5 = definitely melanoma. Results: Our data show that the application of the ABCD rule significantly enhances diagnostic ability in less experienced dermatologists compared wit h rating without the guidance of a scoring system. In contrast, the diagnos tic accuracy of dermatologists who are moderately to greatly experienced is not improved by use of the ABCD rule. Conclusion: Our experiments indicate that the application of the ABCD rule to ELM introduced by Stolz et al represents a useful enhancement for diagno sis of pigmented skin lesions in less experienced users. However, the metho d does fail to detect melanomas with 100% accuracy. Therefore further effor t has to be made to make the diagnosis of melanoma easier and more accurate .