Draft Key Questions
Disposition of Comments Report
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Archived: This report is greater than 3 years old. Findings may be used for research purposes, but should not be considered current.
Cancers of the skin are the most common forms of cancer. Timely diagnosis and treatment are critical to reducing the rates of morbidity and mortality. Newer noninvasive imaging technologies may assist with earlier detection.
To provide an objective description of noninvasive imaging modalities in diagnosing cancerous tumors of the skin, to proffer an analytic framework for assessing the applications of the imaging modalities, to summarize the state of ongoing research, and to delineate future research needs.
We searched the MEDLINE® database for English-language literature published between 1990 and March 2011 for selected noninvasive imaging technologies. We included all publications types and study designs. We extracted data solely from relevant abstracts. Our search also included grey literature (manufacturers’ Web sites, Food and Drug Administration’s relevant databases, and ClinicalTrials.gov), and incorporated expert input from our key informants. Devices were classified as in general clinical use, limited clinical use, or investigational use, based on all available information.
We screened in 629 abstracts that were relevant to the noninvasive imaging technologies of interest. Only 11 abstracts were on randomized controlled trials. Of the devices in general clinical use, we found a total of 51 abstracts on photography and 433 on dermoscopy. Of note, only one abstract reported clinical outcomes. None of the abstracts reported adverse events. Photography is principally used in specialty and subspecialty settings (i.e., oncology) and while widely used by dermatologists, dermoscopy is still not used in primary care. We did not identify any consistent guidelines for the assessment of suspicious skin lesions. Devices in limited clinical use are principally used in research settings. Available literature was limited for these devices as well as those still considered investigational.
A review of the literature reveals predominant use of noninvasive devices by dermatologists with limited diffusion of this technology in primary care. When compared with the use of biopsy, future research is needed to evaluate the test accuracies, clinical impact, and the potential adverse events associated with the use of noninvasive imaging technologies.