title: Accuracy and predictors of basal cell carcinoma diagnosis.
abstract: BACKGROUND
  Basal cell carcinoma (BCC) is the most common cancer in the United States. Therefore, prospective assessment of dermatologists' acumen in diagnosing BCC is important but, unfortunately, is lacking. OBJECTIVE. We sought to determine the positive predictive value (PPV) for clinically diagnosing BCC based on how confident the physician is of the diagnosis. We also sought to determine which clinical and historical factors most influence a dermatologist's perception that a tumor is a BCC and to determine which factors are correlated with a lesion being a BCC.
  
  
  METHODS
  Dermatology attending faculty at the University of Miami performing biopsies on their patients in whom BCC was a consideration were asked to complete a questionnaire. They recorded how confident they were of their clinical diagnosis of BCC. They also recorded various clinical and historical factors about the patients and the lesions biopsied.
  
  
  RESULTS
  The PPV for clinically diagnosing BCC when the clinician was most confident was 80%. Age (> 64 years) and the presence of pigmentation, telangiectasias, and a pearly border were statistically associated with a greater confidence level and a histologic diagnosis of BCC. Sunscreen use was associated with fewer diagnoses of BCCs.
  
  
  CONCLUSIONS
  This is the first study to determine a relevant PPV for the clinical diagnosis of BCC because the PPV was based on clinical confidence level. These results highlight the role of diagnostic biopsies, could improve patient referral, and may help increase the PPV in the future.
authors.affiliation: Department of Dermatology and Cutaneous Surgery, University of Miami, Miami, Florida, USA.
authors.forename: Jordan B
authors.initials: JB
authors.lastname: Schwartzberg
authors.forename: George W
authors.initials: GW
authors.lastname: Elgart
authors.forename: Paolo
authors.initials: P
authors.lastname: Romanelli
authors.forename: Ma
authors.initials: M
authors.lastname: Fangchao
authors.forename: Daniel G
authors.initials: DG
authors.lastname: Federman
authors.forename: Robert S
authors.initials: RS
authors.lastname: Kirsner
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001706:Biopsy; D002280:Basal Cell Carcinoma / Q000175:diagnosis* / Q000473:pathology; D003657:Decision Making; D003880:Dermatology / Q000592:standards*; D005260:Female; D005431:Florida; D006801:Humans; D007600:Judgment; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D010818:Practice Patterns, Physicians' / Q000592:standards*; D011237:Predictive Value of Tests; D012878:Skin Neoplasms / Q000175:diagnosis* / Q000473:pathology; D011795:Surveys and Questionnaires