Assessing the impact of color blindness on the ability of identifying benign and malignant skin lesions by naked-eye examination

BACKGROUND: Color vision deficiency describes the inability to distinguish certain shades of color. The aim of this study was to assess the impact of having color vision deficiency on the accuracy of distinguishing benign and malignant skin lesions by naked-eye examination. METHODS: This was a cross-sectional study conducted during the period August 2020 to February 2021. We randomly selected a total of 20 nevi and 20 melanoma images from an open access image database. The 40 images were divided into four sets of images, each set contained 5 benign and 5 malignant skin lesion images simulated as if they were seen by a protanope physician, deuteranope physician, tritanope physician, and a set of images presented without simulation. In an online survey, students who were in their final year of medical school or had newly graduated were asked to diagnose each image as benign or malignant. RESULTS: A total of 140 participants were included with a mean (SD) age of 24.88 (1.51). We found a significantly higher mean accuracy for non-simulated images compared to deuteranope simulated images (p< 0.001, mean difference = 11.07, 95% CI 8.40 to 13.74). We did not find a significant difference in accuracy classification for protanope simulated images (p = 0.066), nor for tritanope simulated images (p = 0.315). Classification accuracy for malignant lesions was higher than classification accuracy for benign lesions, with the highest difference belonging to deuteranope simulated images, with a difference in mean accuracy of classifying malignant lesions by 32.2 (95% CI 27.0 to 37.6). CONCLUSION: Deuteranope participants (i.e., green color deficiency) had a significantly lower accuracy of distinguishing pigmented skin lesions as benign or malignant, an impact not found for other color vision deficiencies, which was mainly for misdiagnosing benign lesions as malignant.