• Scott W Menzies, Leanne Bischof, Hugues Talbot, Alex Gutenev, Michelle Avramidis, Livian Wong, Sing Kai Lo, Geoffrey Mackellar, Victor Skladnev, William McCarthy, John Kelly, Brad Cranney, Peter Lye, Harold Rabinovitz, Margaret Oliviero, Andreas Blum, Alexandra Varol, Alexandra Virol, Brian De'Ambrosis, Roderick McCleod, Hiroshi Koga, Caron Grin, Ralph Braun, and Robert Johr.
• Sydney Melanoma Diagnostic Centre, Sydney Cancer Centre, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia. scott.menzies@email.cs.nsw.gov.au
• Arch Dermatol. 2005 Nov 1; 141 (11): 1388-96.

ObjectiveTo describe the diagnostic performance of SolarScan (Polartechnics Ltd, Sydney, Australia), an automated instrument for the diagnosis of primary melanoma.DesignImages from a data set of 2430 lesions (382 were melanomas; median Breslow thickness, 0.36 mm) were divided into a training set and an independent test set at a ratio of approximately 2:1. A diagnostic algorithm (absolute diagnosis of melanoma vs benign lesion and estimated probability of melanoma) was developed and its performance described on the test set. High-quality clinical and dermoscopy images with a detailed patient history for 78 lesions (13 of which were melanomas) from the test set were given to various clinicians to compare their diagnostic accuracy with that of SolarScan.SettingSeven specialist referral centers and 2 general practice skin cancer clinics from 3 continents. Comparison between clinician diagnosis and SolarScan diagnosis was by 3 dermoscopy experts, 4 dermatologists, 3 trainee dermatologists, and 3 general practitioners.PatientsImages of the melanocytic lesions were obtained from patients who required either excision or digital monitoring to exclude malignancy.Main Outcome MeasuresSensitivity, specificity, the area under the receiver operator characteristic curve, median probability for the diagnosis of melanoma, a direct comparison of SolarScan with diagnoses performed by humans, and interinstrument and intrainstrument reproducibility.ResultsThe melanocytic-only diagnostic model was highly reproducible in the test set and gave a sensitivity of 91% (95% confidence interval [CI], 86%-96%) and specificity of 68% (95% CI, 64%-72%) for melanoma. SolarScan had comparable or superior sensitivity and specificity (85% vs 65%) compared with those of experts (90% vs 59%), dermatologists (81% vs 60%), trainees (85% vs 36%; P =.06), and general practitioners (62% vs 63%). The intraclass correlation coefficient of intrainstrument repeatability was 0.86 (95% CI, 0.83-0.88), indicating an excellent repeatability. There was no significant interinstrument variation (P = .80).ConclusionsSolarScan is a robust diagnostic instrument for pigmented or partially pigmented melanocytic lesions of the skin. Preliminary data suggest that its performance is comparable or superior to that of a range of clinician groups. However, these findings should be confirmed in a formal clinical trial.

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