cqvip:Background. The clinical history of a given pigmented lesion could in fluence the therapeutic decision. Teledermatology and automated image analysis also hold great potential for revolutionizing dermatology services. Aim. The aim of this retrospective study was to evaluate the diagnostic accuracy of users with differ ent experiences in dermoscopy with and without information about patients and th eir history compared with classification by an automated analysing system. Setti ng. One hundred and fifty-seven dermoscopic images of pigmented lesions, taken and proved by histopathology at the Pigmented Lesions Clinic of theDepartment o f Dermatology of the University Tuebingen,Germany, were included. Methods. All i mages were viewed by three investigators with different experience: excellent (A ), average (B) and beginner (C). In the first dermoscopic classification, no inf ormation was available. After 3 months the same images were once more classified by the three investigators, now with the information about the patients and the ir history. The melanocytic lesions were tested by the Tuebinger Mole Analyser. Results. For user A the sensitivity, specificity and diagnostic accuracy reveale d no improvement on including the history (81.3% to 84.4% , 94.6% to 92.3% and 92.0% to 90.7% ), whereas user B clearly improved his results (75.0% to 87.5% , 76.9% to 88.5% and 76.5% to 88.3% ). No change in the sensiti vity was seen by user C (84.4% ), but there was a clear improvement in the spec ificity (69.2% to 87.7% )-and diagnostic accuracy (72.2% to 87.0% ). Usi ng the computer algorithm, a sensitivity of 100% , a specificity of 76.9% and a diagnostic accuracy of 81.9% were achieved. Conclusions. The study revealed results relevant to the use of dermoscopy: (1) continuing dermoscopic education influences the diagnostic accuracy; (2) the history is helpful for averaged use rs and beginners in dermoscopy; (3) digital image analysis has the highest sensi tivity, but a lower specificity compared to the clinicians; and (4) digital derm oscopy could be used for store-and-forward systems in teledermoscopy.
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