A total of 212 participants were included in the study: 177 dermatologists, 9 nondermatologist physicians, 14 physician assistants, 7 nurse practitioners, and 5 unidentified clinicians. Data from all participants were eligible for analysis (
Figure). Overall, sensitivity was 63% after participants reviewed clinical images, 65% after they reviewed dermatoscopic images, and 83% after they reviewed MSDSLA findings (
P<.001). Specificity was 59% after review of clinical images, 40% after review of dermatoscopic images, and 76% after review of MSDSLA findings (
P<.001). Biopsy decision accuracy was 61% after review of clinical images, 52% after review of dermatoscopic images, and 80% after review of MSDSLA findings (
P<.001). Positive predictive value was 61% after review of clinical images, 52% after review of dermatoscopic images, and 80% after review of MSDSLA findings (
P<.001). Negative predictive value decreased from 61% after review of clinical images to 53% after review of dermatoscopic images and increased to 82% (
P<.001) after review of MSDSLA findings. The number of lesions participants indicated that they would biopsy increased significantly from 52% after review of clinical images to 63% after review of dermatoscopic images (
P<.001). However, the overall number of specimens participants indicated that they would biopsy did not change significantly after they reviewed MSDSLA findings.
Participants were also significantly less likely to perform biopsies on lesions that were not melanoma, high-grade dysplastic nevus, or atypical melanocytic hyperplasia after reviewing MSDSLA findings than after reviewing the clinical and dermatoscopic images. Therefore, although the total number of specimens selected for biopsy did not increase with MSDSLA findings, participants’ biopsy decision accuracy improved, with more melanomas and fewer lower-risk PSLs being selected.