Skip to main content
PMC home page
The BMJ logoLink to The BMJ
. 1989 Jul 1;299(6690):16–18. doi: 10.1136/bmj.299.6690.16

Accuracy in clinically evaluating pigmented lesions.

R K Curley 1, M G Cook 1, M E Fallowfield 1, R A Marsden 1
PMCID: PMC1837000  PMID: 2503192

Abstract

OBJECTIVE--To determine the ability of three doctors experienced in managing melanocytic lesions to diagnose correctly melanoma, dysplastic naevi, and various benign pigmented lesions. DESIGN--Independent clinical evaluation and histopathological assessment. SETTING--Pigmented lesion clinic, which patients attend without an appointment for early diagnosis of melanoma. PATIENTS--86 Patients with lesions that were judged to be benign by at least one of the three doctors. INTERVENTIONS--The lesions were excised under local anaesthesia and sent for histopathological examination in coded bottles without clinical details. MAIN OUTCOME MEASURE--Comparison of clinical with histopathological diagnosis for each lesion. RESULTS--A total of 120 lesions were evaluated by at least two of the three doctors. The histopathological diagnoses were made by the same pathologist. The overall sensitivity (diagnostic accuracy) for the three doctors for all types of lesion was 50%. Of the 39 dysplastic naevi, only 19 were identified correctly by all observers, and a further 24 banal lesions were wrongly diagnosed as dysplastic by at least one doctor. Particular difficulty was experienced with small (less than 5 mm), flat lesions, which can be banal or potentially malignant. CONCLUSIONS--Critical diagnosis and management decisions concerning pigmented lesions should always be based on a combination of clinical and histopathological assessments and the history of the patient.

Full text

PDF
16

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. BECKER S. W. Pitfalls in the diagnosis and treatment of melanoma. AMA Arch Derm Syphilol. 1954 Jan;69(1):11–30. doi: 10.1001/archderm.1954.01540130013002. [DOI] [PubMed] [Google Scholar]
  2. Cassileth B. R., Clark W. H., Jr, Lusk E. J., Frederick B. E., Thompson C. J., Walsh W. P. How well do physicians recognize melanoma and other problem lesions? J Am Acad Dermatol. 1986 Apr;14(4):555–560. doi: 10.1016/s0190-9622(86)70068-6. [DOI] [PubMed] [Google Scholar]
  3. Clark W. H., Jr, Elder D. E., Guerry D., 4th, Epstein M. N., Greene M. H., Van Horn M. A study of tumor progression: the precursor lesions of superficial spreading and nodular melanoma. Hum Pathol. 1984 Dec;15(12):1147–1165. doi: 10.1016/s0046-8177(84)80310-x. [DOI] [PubMed] [Google Scholar]
  4. Cook M. G., Robertson I. Melanocytic dysplasia and melanoma. Histopathology. 1985 Jun;9(6):647–658. doi: 10.1111/j.1365-2559.1985.tb02845.x. [DOI] [PubMed] [Google Scholar]
  5. EWING M. R., POWELL T. Some observations on the diagnosis of clinically pigmented skin tumours. Br J Surg. 1951 Apr;38(152):442–454. doi: 10.1002/bjs.18003815205. [DOI] [PubMed] [Google Scholar]
  6. Elder D. E., Goldman L. I., Goldman S. C., Greene M. H., Clark W. H., Jr Dysplastic nevus syndrome: a phenotypic association of sporadic cutaneous melanoma. Cancer. 1980 Oct 15;46(8):1787–1794. doi: 10.1002/1097-0142(19801015)46:8<1787::aid-cncr2820460816>3.0.co;2-s. [DOI] [PubMed] [Google Scholar]
  7. English J. S., Swerdlow A. J., MacKie R. M., O'Doherty C. J., Hunter J. A., Clark J., Hole D. J. Relation between phenotype and banal melanocytic naevi. Br Med J (Clin Res Ed) 1987 Jan 17;294(6565):152–154. doi: 10.1136/bmj.294.6565.152. [DOI] [PMC free article] [PubMed] [Google Scholar]
  8. English J. S., Swerdlow A. J., Mackie R. M., O'Doherty C. J., Hunter J. A., Clark J., Hole D. J. Site-specific melanocytic naevus counts as predictors of whole body naevi. Br J Dermatol. 1988 May;118(5):641–644. doi: 10.1111/j.1365-2133.1988.tb02564.x. [DOI] [PubMed] [Google Scholar]
  9. Green A., MacLennan R., Siskind V. Common acquired naevi and the risk of malignant melanoma. Int J Cancer. 1985 Mar 15;35(3):297–300. doi: 10.1002/ijc.2910350303. [DOI] [PubMed] [Google Scholar]
  10. Greene M. H., Clark W. H., Jr, Tucker M. A., Elder D. E., Kraemer K. H., Guerry D., 4th, Witmer W. K., Thompson J., Matozzo I., Fraser M. C. Acquired precursors of cutaneous malignant melanoma. The familial dysplastic nevus syndrome. N Engl J Med. 1985 Jan 10;312(2):91–97. doi: 10.1056/NEJM198501103120205. [DOI] [PubMed] [Google Scholar]
  11. Grob J. J., Andrac L., Romano M. H., Davin D., Collet-Villette A. M., Munoz M. H., Bonerandi J. J. Dysplastic naevus in non-familial melanoma. A clinicopathological study of 101 cases. Br J Dermatol. 1988 Jun;118(6):745–752. doi: 10.1111/j.1365-2133.1988.tb02591.x. [DOI] [PubMed] [Google Scholar]
  12. HUBENER L. F., MCMULLAN F. H. Malignant melanoma; a statistical review of clinical and histological diagnoses. AMA Arch Derm. 1956 Dec;74(6):618–619. [PubMed] [Google Scholar]
  13. Holly E. A., Kelly J. W., Shpall S. N., Chiu S. H. Number of melanocytic nevi as a major risk factor for malignant melanoma. J Am Acad Dermatol. 1987 Sep;17(3):459–468. doi: 10.1016/s0190-9622(87)70230-8. [DOI] [PubMed] [Google Scholar]
  14. Kopf A. W., Mintzis M., Bart R. S. Diagnostic accuracy in malignant melanoma. Arch Dermatol. 1975 Oct;111(10):1291–1292. [PubMed] [Google Scholar]
  15. Rampen F. H., Fleuren B. A. Relation between phenotype and banal melanocytic naevi. Br Med J (Clin Res Ed) 1987 Mar 21;294(6574):773–773. doi: 10.1136/bmj.294.6574.773-a. [DOI] [PMC free article] [PubMed] [Google Scholar]
  16. Rampen F. H., Rümke P. Referral pattern and accuracy of clinical diagnosis of cutaneous melanoma. Acta Derm Venereol. 1988;68(1):61–64. [PubMed] [Google Scholar]
  17. Rampen F. H., van der Meeren H. L., Boezeman J. B. Frequency of moles as a key to melanoma incidence? J Am Acad Dermatol. 1986 Dec;15(6):1200–1203. doi: 10.1016/s0190-9622(86)70290-9. [DOI] [PubMed] [Google Scholar]
  18. Ramsay D. L., Fox A. B. The ability of primary care physicians to recognize the common dermatoses. Arch Dermatol. 1981 Oct;117(10):620–622. [PubMed] [Google Scholar]
  19. Rigel D. S., Friedman R. J. The management of patients with dysplastic and congenital nevi. Dermatol Clin. 1985 Apr;3(2):251–255. [PubMed] [Google Scholar]
  20. SWERDLOW M. Nevi; a problem of misdiagnosis. Am J Clin Pathol. 1952 Nov;22(11):1054–1060. doi: 10.1093/ajcp/22.11.1054. [DOI] [PubMed] [Google Scholar]
  21. Schmoeckel C. How consistent are dermatopathologists in reading early malignant melanomas and lesions "precursor" to them? An international survey. Am J Dermatopathol. 1984 Summer;6 (Suppl):13–24. [PubMed] [Google Scholar]
  22. Swerdlow A. J., English J., MacKie R. M., O'Doherty C. J., Hunter J. A., Clark J., Hole D. J. Benign melanocytic naevi as a risk factor for malignant melanoma. Br Med J (Clin Res Ed) 1986 Jun 14;292(6535):1555–1559. doi: 10.1136/bmj.292.6535.1555. [DOI] [PMC free article] [PubMed] [Google Scholar]
  23. Wagner R. F., Jr, Wagner D., Tomich J. M., Wagner K. D., Grande D. J. Diagnoses of skin disease: dermatologists vs. nondermatologists. J Dermatol Surg Oncol. 1985 May;11(5):476–479. doi: 10.1111/j.1524-4725.1985.tb01406.x. [DOI] [PubMed] [Google Scholar]

Articles from BMJ : British Medical Journal are provided here courtesy of BMJ Publishing Group

RESOURCES