A worthwhile tool in evaluating worrisome lesions

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ABSTRACT

Background: We sought to examine whether electrical impedance spectroscopy (EIS), a diagnostic tool approved by the US Food and Drug Administration for the evaluation of pigmented skin lesions (PSLs), is beneficial to primary care providers (PCPs) by comparing the accuracy of PCPs’ management decisions for PSLs based on visual examination alone with those based on concurrent visual and EIS evaluation.

Methods: Physicians and nurse practitioners (NPs) participated in an anonymous online survey in which they viewed clinical images of PSLs and were asked to make 2 clinical decisions before and after being provided an EIS score that indicated the likelihood that the lesion was a melanoma. They were asked (1) if they would biopsy the lesion/refer the patient out and (2) what they expected the pathology results would show.

Results: Forty-four physicians and 17 NPs participated, making clinical decisions for 1354 presented lesions. Overall, with the addition of EIS to visual inspection of clinical images, the sensitivity of biopsy/referral decisions for melanomas and severely dysplastic nevi (SDN) increased from 69.2% to 90.0% (P < .001), while specificity increased from 44.0% to 72.6% (P < .001). Physicians and NPs, regardless of years of experience, each saw significant improvements in sensitivity, specificity, and diagnostic accuracy with the addition of EIS scores.

Conclusions: The incorporation of EIS data into clinical decision-making by PCPs significantly increased the sensitivity and specificity of biopsy/referral decisions for melanomas and SDN and overall diagnostic accuracy compared with visual inspection alone. The results of this study suggest that diagnostic accuracy for PSLs by PCPs may be improved with adjunctive use of EIS with visual inspection.

Primary care providers (PCPs) are often the first line of defense in detecting skin cancers. For patients with concerning skin lesions, PCPs may choose to perform a biopsy or facilitate access to specialty services (eg, Dermatology). Consequently, PCPs play a critical role in the timely detection of skin cancers, and it is paramount to employ continually improving detection methods, such as the application of technologic advances.¹

Differentiating benign nevi from melanoma and severely dysplastic nevi (SDN), both of which warrant excision, poses a unique challenge to clinicians examining pigmented skin lesions (PSLs). PCPs often rely on visual inspection to differentiate benign skin lesions from malignant skin cancers. In some primary care practices, dermoscopy, which involves using a handheld device to evaluate lesions with polarized light and magnification, is used to improve melanoma detection. However, while visual inspection and dermoscopy are valid, effective techniques for the diagnosis of melanocytic lesions, in many instances they still can lead to missed cancers or unnecessary biopsies and specialty referrals. Adjunctive use of dermoscopy with visual inspection has been shown to increase the probability of skin cancer detection, but it fails to achieve a near-100% success rate.² Furthermore, dermoscopy is heavily user-dependent, requiring significant training and experience for appropriate use.³

Another option is an electrical impedance spectroscopy (EIS) device (Nevisense, Scibase, Stockholm, Sweden), which has been approved by the US Food and Drug Administration (FDA) to assist in the detection of melanoma and differentiation from benign PSLs.⁴ EIS is a noninvasive, rapidly applied technology designed to accompany the visual examination of melanocytic lesions in office, with or without dermoscopy. Still relatively new, the technology is employed today by many dermatologists, increasing diagnostic accuracy for PSLs.⁵ The lightweight and portable instrument features a handheld probe, which is held against a lesion to obtain a reading. EIS uses a low-voltage electrode to apply a harmless electrical current to the skin at various frequencies.⁶ As benign and malignant tissues vary in cell shape, size, and composition, EIS distinguishes differential electrical resistance of the tissue to aid in diagnosis.⁷

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