EPILUMINESCENCE MICROSCOPY VERSUS CLINICAL-EVALUATION OF PIGMENTED SKIN-LESIONS - EFFECTS OF OPERATORS TRAINING ON REPRODUCIBILITY AND ACCURACY

Background: An acceptable level of reliability is a prerequisite for t he introduction of epiluminescence microscopy (ELM) into the diagnosis of pigmented skin lesions. Objective: To assess the effects of a trai ning program on the reproducibility and accuracy of ELM as compared to clinical evaluation. Methods: Before and after the program, 48 clinic al images and their ELM counterparts were independently evaluated by s even participants. Reproducibility was measured by the kappa index, ac curacy by the rate of exact diagnoses (RED) assuming histology as a re ference. Results: We observed (i) no effect of training on clinical re producibility, (II) an improved reproducibility of ELM diagnoses of no n-melanocytic lesions (NML) and melanomas but not of melanocytic nevi (MN), (iii) a greater increase in the clinical RED of NML and melanoma s compared with MN and (iv) a similar though more pronounced increase in the RED on ELM. Conclusions: The effects of training were greater f or ELM as compared to clinical diagnosis, and for NML and melanomas as compared to MN.