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PLoS One. 2014 Oct 14;9(10):e109339. doi: 10.1371/journal.pone.0109339. eCollection 2014.

Selective use of sequential digital dermoscopy imaging allows a cost reduction in the melanoma detection process: a belgian study of patients with a single or a small number of atypical nevi.

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Department of Dermatology, Centre du Cancer, Cliniques Universitaires St Luc, Université catholique de Louvain, Brussels, Belgium.
Institute of Health and Society, Faculty of Public Health, Université catholique de Louvain, Brussels, Belgium.
Centre for Health Economics Research & Modelling Infectious Diseases, Vaccine & Infectious Disease Institute, Faculty of Medicine & Health Sciences, University of Antwerp, Antwerp, Belgium.
Department of Biomedical Sciences, Institute of Tropical Medicine, Antwerp, Belgium.
Department of Medical Oncology, Centre du Cancer, Cliniques Universitaires St Luc, Université catholique de Louvain, Brussels, Belgium.
Department of Dermatology, Universitair Ziekenhuis, Antwerp, Belgium.
Institute of Statistics, Biostatistics and Actuarial Sciences, Université catholique de Louvain, Louvain-la-Neuve, Belgium.
Department of Dermatology, Lyon 1 University, Centre Hospitalier Lyon Sud, Pierre Bénite, France.



Dermoscopy is a technique which improves melanoma detection. Optical dermoscopy uses a handheld optical device to observe the skin lesions without recording the images. Sequential digital dermoscopy imaging (SDDI) allows storage of the pictures and their comparison over time. Few studies have compared optical dermoscopy and SDDI from an economic perspective.


The present observational study focused on patients with one-to-three atypical melanocytic lesions, i.e. lesions considered as suspicious by optical dermoscopy. It aimed to calculate the "extra-costs" related to the process of melanoma detection. These extra-costs were defined as the costs of excision and pathology of benign lesions and/or the costs of follow-up by SDDI. The objective was to compare these extra-costs when using optical dermoscopy exclusively versus optical dermoscopy with selective use of SDDI.


In a first group of patients, dermatologists were adequately trained in optical dermoscopy but worked without access to SDDI. They excised all suspicious lesions to rule out melanoma. In a second group, the dermatologists were trained in optical and digital dermoscopy. They had the opportunity of choosing between immediate excision or follow-up by SDDI (with delayed excision if significant change was observed). The comparison of extra-costs in both groups was made possible by a decision tree model and by the division of the extra-costs by the number of melanomas diagnosed in each group. Belgian official tariffs and charges were used.


The extra-costs in the first and in the second group were respectively €1,613 and €1,052 per melanoma excised. The difference was statistically significant.


Using the Belgian official tariffs and charges, we demonstrated that the selective use of SDDI for patients with one-to-three atypical melanocytic lesions resulted in a significant cost reduction.

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