title: The independent pathology laboratory as a reporting source for cutaneous melanoma incidence in Iowa, 1977-1994.
abstract: BACKGROUND
  Health care changes during the past decade have resulted in a greater proportion of cutaneous melanoma (CM) cases diagnosed in nonhospital settings, increasing the potential for cases to be missed by population-based cancer registries.
  
  
  OBJECTIVE
  Our purpose was to assess changes in case-finding sources in Iowa from 1977 to 1994 and to determine the extent of underreporting for the State Health Registry of Iowa, a population-based cancer registry.
  
  
  METHODS
  This study examines changing trends in the incidence of CM and compares case-finding sources (hospitals/clinics, hospital pathology laboratories, and independent pathology laboratories). A survey of dermatologists serving Iowans provides estimates of underreporting.
  
  
  RESULTS
  During the period 1977 to 1994, invasive CM increased 82%, whereas in situ CM increased 900%. The proportion of CM cases diagnosed in independent pathology laboratories increased to 25% of all cases. A range of 10.4% to 17.1% underreporting was estimated based on the survey of dermatologists.
  
  
  CONCLUSIONS
  To improve the accuracy of surveillance, population-based cancer registries need to make a greater effort accessing pathology reports from nonhospital settings.
authors.affiliation: Department of Internal Medicine, College of Medicine, University of Iowa, Iowa City 52242, USA.
authors.forename: L A
authors.initials: LA
authors.lastname: Merlino
authors.forename: K J
authors.initials: KJ
authors.lastname: Sullivan
authors.forename: D C
authors.initials: DC
authors.lastname: Whitaker
authors.forename: C F
authors.initials: CF
authors.lastname: Lynch
mesh_terms: D003880:Dermatology / Q000706:statistics & numerical data; D003953:Diagnosis-Related Groups; D005500:Follow-Up Studies; D006761:Hospitals / Q000706:statistics & numerical data; D006785:Hospitals, University / Q000706:statistics & numerical data; D006801:Humans; D015994:Incidence; D007484:Iowa / Q000453:epidemiology; D007753:Laboratories; D008499:Medical Records; D008545:Melanoma / Q000453:epidemiology*; D010044:Outpatient Clinics, Hospital / Q000706:statistics & numerical data; D010336:Pathology; D010337:Pathology Department, Hospital / Q000706:statistics & numerical data; D011159:Population Surveillance; D012042:Registries; D018426:SEER Program; D012878:Skin Neoplasms / Q000453:epidemiology*