TY - JOUR
T1 - Influence of time on dermoscopic diagnosis and management
AU - Jaimes, Natalia
AU - Dusza, Stephen W.
AU - Quigley, Elizabeth A.
AU - Braun, Ralph P.
AU - Puig, Susana
AU - Malvehy, Josep
AU - Kittler, Harald
AU - Rabinovitz, Harold S.
AU - Oliviero, Margaret C.
AU - Soyer, H. Peter
AU - Grichnik, James M.
AU - Korzenko, Adam
AU - Cabo, Horacio
AU - Carlos-Ortega, Blanca
AU - Ahlgrimm-Siess, Verena
AU - Kopf, Alfred W.
AU - Marghoob, Ashfaq A.
PY - 2013/5
Y1 - 2013/5
N2 - Background/Objectives Dermoscopy aids in clinical decision-making. However, time pressure is a common reason precluding its use. We evaluated the effect of time on lesion recognition and management decisions utilising clinical and dermoscopic images. Method In all, 100 dermoscopic images were presented to 15 dermatologists with experience in dermoscopy and seven non-experts (dermatology residents). Each lesion was displayed thrice in succession. The dermoscopic image was initially presented for 1 s (t1). The same dermoscopic image was shown again without time constraints (t2) and then a final time with additional images of the clinical context (t3). Participants provided a diagnosis, their level of confidence and biopsy predilection after evaluating each image. Results For benign lesions, both groups rarely changed their diagnosis. However, an improvement in the number of correct benign diagnoses was observed when the lesion was shown in a clinical context. For malignant lesions, both groups improved when more time and clinical context was given; nevertheless, non-experts were more likely to change the diagnosis towards the correct one as more time was given and tended to perform more biopsies, in particular of benign lesions. Limitations were a small number of participants and an artificial study setting. Conclusion Dermoscopy uses analytical and non-analytical reasoning approaches. We suggest that non-analytical reasoning is employed when rapid clinical decisions need to be made, especially during the evaluation of benign lesions. We conclude that dermoscopy is relatively rapid and non-time-consuming technique that adds relevant information and guides clinicians towards appropriate management decisions.
AB - Background/Objectives Dermoscopy aids in clinical decision-making. However, time pressure is a common reason precluding its use. We evaluated the effect of time on lesion recognition and management decisions utilising clinical and dermoscopic images. Method In all, 100 dermoscopic images were presented to 15 dermatologists with experience in dermoscopy and seven non-experts (dermatology residents). Each lesion was displayed thrice in succession. The dermoscopic image was initially presented for 1 s (t1). The same dermoscopic image was shown again without time constraints (t2) and then a final time with additional images of the clinical context (t3). Participants provided a diagnosis, their level of confidence and biopsy predilection after evaluating each image. Results For benign lesions, both groups rarely changed their diagnosis. However, an improvement in the number of correct benign diagnoses was observed when the lesion was shown in a clinical context. For malignant lesions, both groups improved when more time and clinical context was given; nevertheless, non-experts were more likely to change the diagnosis towards the correct one as more time was given and tended to perform more biopsies, in particular of benign lesions. Limitations were a small number of participants and an artificial study setting. Conclusion Dermoscopy uses analytical and non-analytical reasoning approaches. We suggest that non-analytical reasoning is employed when rapid clinical decisions need to be made, especially during the evaluation of benign lesions. We conclude that dermoscopy is relatively rapid and non-time-consuming technique that adds relevant information and guides clinicians towards appropriate management decisions.
KW - clinical reasoning
KW - confidence
KW - decision-making process
KW - dermoscopy
KW - experience
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U2 - 10.1111/ajd.12001
DO - 10.1111/ajd.12001
M3 - Article
C2 - 23190378
AN - SCOPUS:84876284109
SN - 0004-8380
VL - 54
SP - 96
EP - 104
JO - Australasian Journal of Dermatology
JF - Australasian Journal of Dermatology
IS - 2
ER -