This technology holds the potential to be seamlessly implemented into primary care practice, given that dermatology expertise training is not required to use the EIS device; this could allow for EIS measurement of lesions to be delegated to office staff (eg, nurses, medical assistants).16 Future studies are needed to assess EIS use among PCPs in a real-world setting, where factors such as its application on nonmelanocytic lesions (eg, seborrheic keratoses) and its pairing with patient historical data could produce varying results.
Limitations. While revealing, this study had its limitations. Respondents did not have access to additional pertinent clinical information, such as patients’ histories and risk factors. Clinical decisions in this survey were made based on digital images rather than in vivo examination. This may not represent a real-life evaluation; there is the potential for minimization of the true consequences of a missed melanoma or unnecessary biopsy in the minds of participants, and this does not factor in the operation of the actual EIS device. The Hawthorne effect may also have influenced PCPs’ diagnostic selections. Also, the limited sample size constitutes another limitation.
Of note, in this survey format, respondents rated their inclination to biopsy or refer each lesion from 1 to 5. For statistical analyses, lesions rated 1 to 3 were considered as not biopsied/referred and those rated 4 to 5 as biopsied/referred. The sensitivity and specificity values observed, for both visual examination and concurrent visual and EIS evaluation, are therefore based on this classification system of participants’ provided ratings. It is conceivable that differing sensitivity and specificity values might have been detected if clinicians were instead given a binary choice for referral/biopsy decisions.
CONCLUSIONS
Among PCPs tasked with evaluating melanocytic lesions, the incorporation of EIS data into clinical decision-making in this study significantly increased the sensitivity, specificity, and overall diagnostic accuracy of biopsy or referral decisions for melanomas and SDN compared with visual inspection alone. Overall, the results of this preliminary study suggest that diagnostic accuracy for PSLs by PCPs may be improved with the adjunctive use of EIS with visual inspection. This would ultimately improve patient care and reduce the morbidity and mortality of a melanoma diagnosis.
CORRESPONDENCE
Jonathan Ungar, MD, Kimberly and Eric J. Waldman Department of Dermatology, Icahn School of Medicine at Mount Sinai, 5 East 98th Street, 5th Floor, New York, NY 10029; jonathan.ungar@mountsinai.org