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The "ugly duckling" sign: agreement between observers


Scope, A; Dusza, S W; Halpern, A C; Rabinovitz, H; Braun, R P; Zalaudek, I; Argenziano, G; Marghoob, A A (2008). The "ugly duckling" sign: agreement between observers. Archives of Dermatology, 144(1):58-64.

Abstract

OBJECTIVES: To assess whether multiple observers can identify the same pigmented lesion(s) as being different from a patient's other moles ("ugly duckling" [UD] sign) and to explore whether the UD sign is sensitive for melanoma detection. DESIGN: Baseline back images of 12 patients were obtained from a database of standardized patient images. All patients had at least 8 atypical moles on the back, and in 5 patients, one of the lesions was a histologically confirmed melanoma. The overview back images were supplemented with close-up clinical images of lesions. Participants were asked to evaluate whether the images showed any lesions on the back that differed from other nevi. SETTING: Dermatology clinic specializing in pigmented lesions. PARTICIPANTS: Images were evaluated by 34 participants, including 8 pigmented lesion experts, 13 general dermatologists, 5 dermatology nurses, and 8 nonclinical medical staff. MAIN OUTCOME MEASURES: A lesion was considered a generally apparent UD if it was perceived as different by at least two-thirds of the participants. Sensitivity was defined as the fraction of melanomas identified as different. RESULTS: All 5 melanomas (100%) and only 3 of 140 benign lesions (2.1%) were generally apparent as different. The sensitivity of the UD sign for melanoma detection was 0.9 for the whole group, 1.0 for experts, 0.89 for general dermatologists, 0.88 for nurses, and 0.85 for nonclinicians. A limitation of the study is that assessment was done in virtual settings. CONCLUSIONS: In the present study, melanomas were generally apparent as UDs. The potential of the UD sign for melanoma screening should be further assessed.

OBJECTIVES: To assess whether multiple observers can identify the same pigmented lesion(s) as being different from a patient's other moles ("ugly duckling" [UD] sign) and to explore whether the UD sign is sensitive for melanoma detection. DESIGN: Baseline back images of 12 patients were obtained from a database of standardized patient images. All patients had at least 8 atypical moles on the back, and in 5 patients, one of the lesions was a histologically confirmed melanoma. The overview back images were supplemented with close-up clinical images of lesions. Participants were asked to evaluate whether the images showed any lesions on the back that differed from other nevi. SETTING: Dermatology clinic specializing in pigmented lesions. PARTICIPANTS: Images were evaluated by 34 participants, including 8 pigmented lesion experts, 13 general dermatologists, 5 dermatology nurses, and 8 nonclinical medical staff. MAIN OUTCOME MEASURES: A lesion was considered a generally apparent UD if it was perceived as different by at least two-thirds of the participants. Sensitivity was defined as the fraction of melanomas identified as different. RESULTS: All 5 melanomas (100%) and only 3 of 140 benign lesions (2.1%) were generally apparent as different. The sensitivity of the UD sign for melanoma detection was 0.9 for the whole group, 1.0 for experts, 0.89 for general dermatologists, 0.88 for nurses, and 0.85 for nonclinicians. A limitation of the study is that assessment was done in virtual settings. CONCLUSIONS: In the present study, melanomas were generally apparent as UDs. The potential of the UD sign for melanoma screening should be further assessed.

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Additional indexing

Item Type:Journal Article, refereed, original work
Communities & Collections:04 Faculty of Medicine > University Hospital Zurich > Dermatology Clinic
Dewey Decimal Classification:610 Medicine & health
Language:English
Date:January 2008
Deposited On:18 Feb 2009 15:15
Last Modified:05 Apr 2016 13:01
Publisher:American Medical Association
ISSN:0003-987X
Publisher DOI:10.1001/archdermatol.2007.15
PubMed ID:18209169
Permanent URL: http://doi.org/10.5167/uzh-13976

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