title: Weight of decision-making impairs clinical assessment of melanocytic lesions.
abstract: OBJECTIVE
  We studied the weight of decision-making on clinical assessment of melanocytic lesions judging benign, atypical, and malignant lesions; common mistakes; and total removal rates, comparing dermatologists with nondermatologists.
  
  
  METHODS
  Of 11,246 histopathology specimens, 3,768 had a clinical assessment of melanocytic lesions. Histopathologic diagnosis served as the gold standard.
  
  
  RESULTS
  Benign nevi were assessed most accurately (77%). Dermatologists assessed benign nevi better (p < .0001). The accuracy of clinical assessment in atypical nevi and melanoma was lower (23% and 42%, respectively). Seborrheic keratosis was the most common mistaken diagnosis. Complete removal of clinically benign nevi, atypical nevi, and melanoma was 84%, 90%, and 89%. Decision-making impaired clinical assessement of melanocytic lesions by 5% for dermatologists and 9% for nondermatologists.
  
  
  CONCLUSIONS
  The accuracy of clinical assessment of melanocytic lesions is high for benign nevi, with dermatologists outperforming nondermatologists. Clinicians overestimated malignant potential. Complete removal was more frequent in suspicious lesions. Clinical decision-making impaired assessment by 5 to 9%.
authors.affiliation: Department of Dermatology, University Hospital of Zürich, Zürich, Switzerland.
authors.forename: Tamara
authors.initials: T
authors.lastname: Gächter
authors.forename: Beda
authors.initials: B
authors.lastname: Mühleisen
authors.forename: Leo
authors.initials: L
authors.lastname: Schärer
authors.forename: Reinhard
authors.initials: R
authors.lastname: Dummer
authors.forename: Günter
authors.initials: G
authors.lastname: Burg
authors.forename: Günther F L
authors.initials: GF
authors.lastname: Hofbauer
mesh_terms: D002280:Basal Cell Carcinoma / Q000175:diagnosis; D002983:Clinical Competence; D003657:Decision Making; D003880:Dermatology; D003937:Diagnosis, Differential; D006801:Humans; D017492:Keratosis, Seborrheic / Q000175:diagnosis*; D008545:Melanoma / Q000175:diagnosis*; D009506:Nevus / Q000175:diagnosis*; D018570:Risk Assessment; D012878:Skin Neoplasms / Q000175:diagnosis*