A Clinical Aid for Detecting Skin Cancer: The Triage Amalgamated Dermoscopic Algorithm (TADA)

T. Rogers, MFA; M. L. Marino, MD; S. W. Dusza, DrPH; S. Bajaj, MD; R. P. Usatine, MD; M. A. Marchetti, MD; A. A. Marghoob, MD


J Am Board Fam Med. 2016;29(6):694-701. 

In This Article


Of the 200 attendees who were eligible to participate, 120 (60%) completed the study. A majority of the participants were female (n = 64; 53.3%), half were 50 years of age or less (n = 59; 49.2%), and a large proportion had medical specialties other than dermatology (n = 49; 41%). Of the latter group, 41 (84%) described their specialty as family medicine, family medicine/geriatrics, medicine, or medicine/skin cancer medicine. Over 50 individuals (43.3%) reported no previous dermoscopy training (Table 1). A total of 5641 lesion evaluations were performed (3034 malignant and 2607 benign) with an average of 47 evaluations per participant (of a possible 50).

Overall, TADA had a sensitivity of 94.8% (95% CI, 93.9%–95.5%) and a specificity of 72.3% (95% CI, 70.5%–74.0%) for all study lesions. Sensitivity estimates for melanoma were 94%. Regarding nonmelanoma skin cancers, participants achieved sensitivities of 95% for basal cell carcinoma and 96% for squamous cell. Sensitivity estimates for pigmented versus nonpigmented nonmelanoma skin cancers were 93% versus 96% for basal cell carcinoma, respectively, and 95% versus 97% for squamous cell carcinoma, respectively. Specificities for benign study lesions were 5% for clear cell acanthoma, 63% for nevi, 73% for angioma, 81% for seborrheic keratosis, and 93% for dermatofibroma. The positive predictive value for TADA was 79.9% (95% CI, 78.6%–81.2%) and the negative predictive value was 92.2% (95% CI, 91.0%–93.3%).

Similar estimates of diagnostic performance were seen when stratified by medical specialty (dermatologists vs nondermatologists), prior dermoscopy training, or experience level with dermoscopy (Table 2). Diagnostic sensitivities achieved by individuals with and without previous dermoscopy training (before the first day of the course) were 95.0% (95% CI, 90.9%–99.4%) versus 93.3% (95% CI, 91.5%–95.1%), respectively. Participants with prior dermoscopic training also had similar estimates of diagnostic specificity compared with those without, 76.4% (95% CI, 66.9%–83.1%) versus 74.1% (95% CI, 70.2%–77.5%), respectively.