Augmented decision-making for acral lentiginous melanoma detection using deep convolutional neural networks

Background: Several studies have achieved high-level performance of melanoma detection using convolutional neural networks (CNNs). However, few have described the extent to which the implementation of CNNs improves the diagnostic performance of the physicians. Objective: This study is aimed at developing a CNN for detecting acral lentiginous melanoma (ALM) and investigating whether its implementation can improve the initial decision for ALM detection made by the physicians. Methods: A CNN was trained using 1072 dermoscopic images of acral benign nevi, ALM and intermediate tumours. To investigate whether the implementation of CNN can improve the initial decision for ALM detection, 60 physicians completed a three-stage survey. In Stage I, they were asked for their decisions solely on the basis of dermoscopic images provided to them. In Stage II, they were also provided with clinical information. In Stage III, they were provided with the additional diagnosis and probability predicted by the CNN. Results: The accuracy of ALM detection in the participants was 74.7% (95% confidence interval [CI], 72.6–76.8%) in Stage I and 79.0% (95% CI, 76.7–81.2%) in Stage II. In Stage III, it was 86.9% (95% CI, 85.3–88.4%), which exceeds the accuracy delivered in Stage I by 12.2%p (95% CI, 10.1–14.3%p) and Stage II by 7.9%p (95% CI, 6.0–9.9%p). Moreover, the concordance between the participants considerably increased (Fleiss-κ of 0.436 [95% CI, 0.437–0.573] in Stage I, 0.506 [95% CI, 0.621–0.749] in Stage II and 0.684 [95% CI, 0.621–0.749] in Stage III). Conclusions: Augmented decision-making improved the performance of and concordance between the clinical decisions of a diverse group of experts. This study demonstrates the potential use of CNNs as an adjoining, decision-supporting system for physicians’ decisions.