Selective use of sequential digital dermoscopy imaging allows a cost reduction in the melanoma detection process: a belgian study of patients with a single or a small number of atypical nevi.

Isabelle Tromme,Niko Speybroeck,Luc Thomas,Pauline Richez,Nicolas Praet,Pascal Van Eeckhout,Laurine Sacré,Philippe Beutels,Liliane Marot,Jean-François Baurain,Julien Lambert,Brecht Devleesschauwer,Ivan Theate,Catherine Legrand

doi:10.1371/journal.pone.0109339

Abstract

BackgroundDermoscopy is a technique which improves melanoma detection. Optical dermoscopy uses a handheld optical device to observe the skin lesions without recording the images. Sequential digital dermoscopy imaging (SDDI) allows storage of the pictures and their comparison over time. Few studies have compared optical dermoscopy and SDDI from an economic perspective.ObjectiveThe present observational study focused on patients with one-to-three atypical melanocytic lesions, i.e. lesions considered as suspicious by optical dermoscopy. It aimed to calculate the “extra-costs” related to the process of melanoma detection. These extra-costs were defined as the costs of excision and pathology of benign lesions and/or the costs of follow-up by SDDI. The objective was to compare these extra-costs when using optical dermoscopy exclusively versus optical dermoscopy with selective use of SDDI.MethodsIn a first group of patients, dermatologists were adequately trained in optical dermoscopy but worked without access to SDDI. They excised all suspicious lesions to rule out melanoma. In a second group, the dermatologists were trained in optical and digital dermoscopy. They had the opportunity of choosing between immediate excision or follow-up by SDDI (with delayed excision if significant change was observed). The comparison of extra-costs in both groups was made possible by a decision tree model and by the division of the extra-costs by the number of melanomas diagnosed in each group. Belgian official tariffs and charges were used.ResultsThe extra-costs in the first and in the second group were respectively €1,613 and €1,052 per melanoma excised. The difference was statistically significant.ConclusionsUsing the Belgian official tariffs and charges, we demonstrated that the selective use of SDDI for patients with one-to-three atypical melanocytic lesions resulted in a significant cost reduction.

Highlights

Cutaneous melanoma is one of the prime causes of death by cancer in the young Caucasian adult population [1]
In a first group of patients, dermatologists were adequately trained in optical dermoscopy but worked without access to Sequential digital dermoscopy imaging (SDDI)
Using the Belgian official tariffs and charges, we demonstrated that the selective use of SDDI for patients with one-to-three atypical melanocytic lesions resulted in a significant cost reduction

Summary

Introduction

Cutaneous melanoma is one of the prime causes of death by cancer in the young Caucasian adult population [1]. Optical dermoscopy (OD) is a non-invasive technique that uses a handheld, magnifying, optical device that suppresses light reflection by the stratum corneum either by liquid immersion or by cross-light polarization. It allows the observation of features invisible to the naked eye. Its efficacy to improve diagnostic accuracy for melanoma in a clinical setting has been proven in a meta-analysis [3]. This improvement is linked to examiners’ training and experience in the technique [4]. Few studies have compared optical dermoscopy and SDDI from an economic perspective

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