We're unable to sign you in at this time. Please try again in a few minutes.
We were able to sign you in, but your subscription(s) could not be found. Please try again in a few minutes.
There may be a problem with your account. Please contact the AMA Service Center to resolve this issue.
Contact the AMA Service Center:
Telephone: 1 (800) 262-2350 or 1 (312) 670-7827  *   Email: subscriptions@jamanetwork.com
Error Message ......
Correspondence |

Dermoscopy Not Yet Shown to Increase Sensitivity of Melanoma Diagnosis in Real Practice—Reply

Scott W. Menzies, MBBS, PhD
Arch Dermatol. 2007;143(5):659-675. doi:10.1001/archderm.143.5.665.
Text Size: A A A
Published online


In reply

I read with interest the comments by Carli regarding the lack of evidence for dermoscopy increasing the sensitivity for melanoma in the field. As he correctly stated, all of the evidence cited showing an increased sensitivity for the diagnosis of melanoma compares a clinical diagnosis of melanoma (yes or no) with naked-eye vs dermoscopy examination on lesions excised. It is a requirement for diagnostic devices to be contrasted with a gold standard, which in this field is histopathologic diagnosis. As admitted by Carli, there is unquestioned evidence that dermoscopy increases the correct diagnosis of histopathologically proven melanoma compared with naked-eye examination in this setting, and unless he states that the melanomas in these studies were not representative of melanomas seen in the field, we can be confident that a clinician trained in dermoscopy will correctly diagnose melanoma at a significantly higher rate (19% higher based on meta-analysis results) than with naked-eye examination alone.1 Carli, however, claims that the incorrect diagnosis seen with naked-eye examination may not equate with incorrect management, in that equivocal misclassified lesions may be excised. Hence, in the field, dermoscopy may not improve sensitivity. However, is there any evidence, theoretical or real, for this assumption?

Sign in

Purchase Options

• Buy this article
• Subscribe to the journal
• Rent this article ?

First Page Preview

View Large
First page PDF preview





Also Meets CME requirements for:
Browse CME for all U.S. States
Accreditation Information
The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
Please click the checkbox indicating that you have read the full article in order to submit your answers.
Your answers have been saved for later.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
Commitment to Change (optional):
Indicate what change(s) you will implement in your practice, if any, based on this CME course.
Your quiz results:
The filled radio buttons indicate your responses. The preferred responses are highlighted
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.


Some tools below are only available to our subscribers or users with an online account.

5 Citations

Sign in

Purchase Options

• Buy this article
• Subscribe to the journal
• Rent this article ?

Related Content

Customize your page view by dragging & repositioning the boxes below.

Articles Related By Topic
Related Collections
PubMed Articles

The Rational Clinical Examination: Evidence-Based Clinical Diagnosis

The Rational Clinical Examination: Evidence-Based Clinical Diagnosis
Make the Diagnosis: Melanoma