Accuracy in clinically evaluating pigmented lesions.
OBJECTIVE
To determine the ability of three doctors experienced in managing melanocytic lesions to diagnose correctly melanoma, dysplastic naevi, and various benign pigmented lesions.


METHODS
Independent clinical evaluation and histopathological assessment.


METHODS
Pigmented lesion clinic, which patients attend without an appointment for early diagnosis of melanoma.


METHODS
86 Patients with lesions that were judged to be benign by at least one of the three doctors.


METHODS
The lesions were excised under local anaesthesia and sent for histopathological examination in coded bottles without clinical details.


METHODS
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.
Curley
R K
RK
Department of Dermatology, St George's Hospital, London.
Cook
M G
MG
Fallowfield
M E
ME
Marsden
R A
RA
D003937:Diagnosis, Differential; D006801:Humans; D007911:Lentigo / Q000175:diagnosis; D008545:Melanoma / Q000175:diagnosis*; D009508:Nevus, Pigmented / Q000175:diagnosis*; D010859:Pigmentation Disorders / Q000175:diagnosis; D012878:Skin Neoplasms / Q000175:diagnosis*