Epiluminescence microscopy versus clinical evaluation of pigmented skin lesions: Effects of operator's training on reproducibility and accuracy

Background: An acceptable level of reliability is a prerequisite for the introduction of epiluminescence microscopy (ELM) into the diagnosis of pigmented skin lesions. Objective: To assess the effects of a training program on the reproducibility and accuracy of ELM as compared to clinical evaluation. Methods: Before and after the program, 48 clinical images and their ELM counterparts were independently evaluated by seven participants. Reproducibility was measured by the κ index, accuracy by the rate of exact diagnoses (RED) assuming histology as a reference. Results: We observed (i) no effect of training on clinical reproducibility, (II) an improved reproducibility of ELM diagnoses of non-melanocytic lesions (NML) and melanomas but not of melanocytic nevi (MN), (iii) a greater increase in the clinical RED of NML and melanomas compared with MN and (iv) a similar though more pronounced increase in the RED on ELM. Conclusions: The effects of training were greater for ELM as compared to clinical diagnosis, and for NML and melanomas as compared to MN.