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Acta Derm Venereol 1998 Jul;78(4):284-8
Department of Dermatology, Danderyd Hospital, Sweden.
While the early detection of malignant melanoma is important and has been emphasized widely in the past few years, it is difficult to accomplish. The purpose of this study is to assess how well dermatologists recognize malignant melanomas in patients with naevi. Information from 9,121 patients visiting two dermatological clinics in Stockholm and diagnosed melanocytic naevi was linked with the Swedish Cancer Registry to identify individuals with records of malignant melanoma. One-hundred-and-thirteen cases of malignant melanoma were detected in the study population. Sixty patients were diagnosed malignant melanoma prior to the naevus diagnosis and most of them were under continuous follow-up. A further 35 patients were diagnosed malignant melanoma and naevus at the same time. The remaining 18 were given the diagnoses malignant melanoma after the naevus diagnosis and, of these, 6 cases were detected more than 6 years after examination and malignant melanoma was considered not present at the time of consultation. Three cases can be considered as missed (6%) and four others as partially missed or delayed. Thus, of 47 cases of probable recognizable malignant melanoma, there was insufficient management of 7 (15%). Six cases were detected during dermatological examination for other conditions and five through general examination of naevi. Although a few possibly detectable malignant melanomas were not discovered, the results of this study reflect a high clinical detection rate. In addition, a number of cases were discovered by chance during examinations for other dermatological conditions.
PMID: 9689297, UI: 98353722
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Br J Dermatol 1998 Feb;138(2):283-7
University Department of Dermatology, Western Infirmary, Glasgow, U.K.
Diagnostic accuracy for melanoma was determined in a dedicated pigmented lesion clinic. We assessed the impact of duration of experience in dermatology and also the relationship between tumour thickness and accuracy of clinical diagnosis. We reviewed the histopathology request forms and reports for all biopsies generated by the Pigmented Lesion Clinic, Western Infirmary, Glasgow during 1992-94 inclusive. The clinic is staffed by two consultants, one senior registrar and one registrar. Diagnostic accuracy, index of suspicion, sensitivity, specificity and positive predictive value were calculated for the clinic overall, and for each grade of staff. One hundred and sixty-three lesions were diagnosed clinically as melanoma. A histopathological diagnosis of melanoma was made for 128 lesions during this period, 113 of which had been correctly diagnosed before surgery. The diagnostic accuracy for two dermatologists each with > 10 years experience in dermatology was 80%, with sensitivity of 91% and positive predictive value of 86%. Diagnostic accuracy rates for two senior registrars (each with 3-5 years experience) and six registrars (each with 1-2 years experience) were 62% and 56%, respectively. Thin and intermediate thickness melanomas generated the greatest inaccuracy irrespective of clinical experience, although registrars failed to recognize melanoma three times more often than the other groups. We report the diagnostic accuracy for melanoma by trained dermatologists to be higher than previously reported. In comparison with trainees, > 10 years experience in dermatology and exposure to more than 10 melanomas per year appears to be associated with greater diagnostic accuracy. Knowledge of the current clinical diagnostic accuracy at varying levels of experience is essential if the impact of training is to be evaluated. As pigmented lesions of virtually all types can be treated within dermatology departments, dermatologists are the appropriate first point of referral for suspected early melanoma.
PMID: 9602875, UI: 98265585
Australas J Dermatol 1998 Feb;39(1):31-3
Skin and Cancer Foundation Australia, Sydney, Australia.
Clinical diagnosis of melanoma can be difficult. A review of the accuracy of clinical diagnosis of melanoma, over a 12 month period, was undertaken at the Skin and Cancer Foundation Australia. The overall accuracy rate was 65.6% with seborrhoeic keratosis, melanocytic naevi and basal cell carcinoma the most common clinical misdiagnoses given to melanoma. Specialist doctors with more than 10 years experience had a higher rate of correct diagnosis than trainee doctors with 0-5 years experience.
PMID: 9529686, UI: 98190591
J Am Acad Dermatol 1995 Jul;33(1):59-63
Department of Dermatology, Sint Anna Hospital, Oss, The Netherlands.
BACKGROUND: Few data are available on the accuracy of visual skin examination by dermatologists as a skin cancer and melanoma screening tool. OBJECTIVE: The purpose of this study was to assess the number of false-negative findings in a skin cancer-melanoma screening program. METHODS: We obtained follow-up information regarding 1551 persons with a negative screening result in a skin cancer-melanoma screening program in 1990. Follow-up was established by record linkage with two different population-based registries. RESULTS: Fifteen persons had new skin cancers. Three of their lesions had been present at the original screening and had probably been missed; 12 were genuinely new. No melanomas were among the missed cases. The calculated sensitivity of the screening was 93.3%, its specificity was 97.8%, its positive predictive value was 54.0%, and its negative predictive value was 99.8%. CONCLUSION: Visual examination by dermatologists as a screening tool for skin cancer and melanoma is appropriate.
PMID: 7601947, UI: 95325432
J Dermatol 1994 Jul;21(7):461-4
Department of Dermatology, Karolinska Hospital, Stockholm, Sweden.
The diagnostic pattern of malignant melanoma and clinical suspicion rate has been investigated at a dermatological university clinic. Of 174 histologically proven malignant melanomas, 60 (34%) were not clinically suspected as melanomas. The accuracy of clinical diagnosis increased with level of experience. Physicians with < 1 year experience in dermatology were able to detect malignant melanoma as the first diagnosis in 31% of the cases in contrast to 63% for those with > 10 years experience. Of 50 patients immediately referred from the dermatologic clinic to surgery departments, 12 did not have melanoma.
PMID: 8089364, UI: 94375728
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