Applying a decision support system in clinical practice: results from melanoma diagnosis

The work reported in this paper investigates the use of a decision-support tool for the diagnosis of pigmented skin lesions in a real-world clinical trial with 511 patients and 3827 lesion evaluations. We analyzed a number of outcomes of the trial, such as direct comparison of system performance in laboratory and clinical setting, the performance of physicians using the system compared to a control dermatologist without the system, and repeatability of system recommendations. The results show that system performance was significantly less in the real-world setting compared to the laboratory setting (c-index of 0.87 vs. 0.94, p = 0.01). Dermatologists using the system achieved a combined sensitivity of 85% and combined specificity of 95%. We also show that the process of acquiring lesion images using digital dermoscopy devices needs to be standardized before sufficiently high repeatability of measurements can be assured.