Patients’ Confidence in Dermoscopical Methods for Detection of Malignant Melanoma

Abstract

Background: At present, different methods are available for the detection of malignant melanoma or for monitoring of melanocytic nevi (MN). Diagnostic accuracy and time consumption increase from naked-eye inspection (NEI) to handheld dermoscopy (HHD), digital dermoscopy (DD) including image analysis, and teledermoscopy (TD) supported by a specialist in dermoscopy. Effectiveness in daily routine depends on both physician’s experience and patient’s compliance. Objective: To analyse patient’s confidence in these diagnostic tools. Material and Methods: A self-administered survey was performed in consecutive patients after examination of MN at 13 private dermatological practices and at the Department of Dermatology of the University of Regensburg. Confidence was assessed by a 5-step ordinal scale ranging from 1 to 5 (higher values indicate higher confidence) and by willingness-to-pay (wtp) as health-economic instrument. Additionally, wtp was assessed for a hypothetical method promising 100% accuracy. Results: Data of 96 patients (mean age 35 years, 56% female) could be analysed. Mean confidence was 1.8 ± 0.9 for NEI, 2.9 ± 0.8 for HHD, 4.3 ± 0.6 for DD, and 4.8 ± 0.7 for TD. Mean wtp per examination was 0.6% ± 0.9 of monthly income (EUR 12.70 ± 15.40) for NEI, 1.2% ± 1.8 (EUR 23.60 ± 20.40) for HHD, 2.9% ± 3.1 (EUR 55.50 ± 42.30) for DD, 3.2% ± 3.9 (EUR 57.90 ± 42.60) for TD, and 5.3% ± 8.1 (EUR 96.10 ± 69.10) for the hypothetical method. Differences between methods were statistically significant (p < 0.001). Compared to the hypothetical method, NEI achieved only 13.2%, HHD 24.6%, DD 57.7%, and TD 60.2% of maximum confidence. Conclusions: Patients’ confidence was highest for TD, HHD was clearly underestimated. Wtp was similar for DD and TD – the best methods available at present – but still 40% lower than for a hypothetical diagnostic method providing 100% accuracy. Better information of patients about the diagnostic accuracy of different methods for detection of malignant melanoma is necessary in order to increase their confidence and compliance.