title: Dermatologists' accuracy in early diagnosis of melanoma of the nail matrix.
abstract: OBJECTIVE
  To measure and compare the accuracy of 4 different clinical methods in the diagnosis of melanoma in situ of the nail matrix among dermatologists with different levels of clinical experience.
  
  
  METHODS
  Twelve cases of melanonychias (5 melanomas and 7 nonmelanomas) were presented following 4 successive steps: (1) clinical evaluation, (2) evaluation according to the ABCDEF rule, (3) dermoscopy of the nail plate, and (4) intraoperative dermoscopy. At each step, the dermatologists were asked to decide if the lesion was a melanoma.
  
  
  METHODS
  The test was administered at 2 dermatological meetings in 2008.
  
  
  METHODS
  A total of 152 dermatologists, including 11 nail experts, 53 senior dermatologists, and 88 junior dermatologists.
  
  
  METHODS
  The answers were evaluated as percentage of right answers for each diagnostic step according to the different grade of expertise. Differences among the percentage of right answers in the different steps were evaluated with the z test at a 5% level of significance. The agreement was investigated using Cohen kappa statistic.
  
  
  RESULTS
  The only method that statistically influenced the correct diagnosis for each category (experts, seniors, and juniors) was intraoperative dermoscopy (z test; P < .05). Cohen kappa statistic showed a moderate interobserver agreement.
  
  
  CONCLUSIONS
  Overall accuracy of dermatologists in the diagnosis of nail matrix melanoma in situ is low because the percentages of physicians who indicated the correct diagnosis during each of the first 3 clinical steps of the test ranged from 46% to 55%. The level of expertise did not statistically influence the correct diagnosis.
authors.affiliation: Departments of Dermatology, Hospital do Servidor Público Municipal de Sâo Paulo, Brazil.
authors.forename: Nilton
authors.initials: N
authors.lastname: Di Chiacchio
authors.forename: Sergio Henrique
authors.initials: SH
authors.lastname: Hirata
authors.forename: Mauro Yoshiaki
authors.initials: MY
authors.lastname: Enokihara
authors.forename: Nilceo S
authors.initials: NS
authors.lastname: Michalany
authors.forename: Gabriella
authors.initials: G
authors.lastname: Fabbrocini
authors.forename: Antonella
authors.initials: A
authors.lastname: Tosti
mesh_terms: D000328:Adult; D002983:Clinical Competence; D003880:Dermatology / Q000193:education; D046169:Dermoscopy; D042241:Early Diagnosis; D006801:Humans; D008545:Melanoma / Q000473:pathology* / Q000601:surgery; D009260:Nail Diseases / Q000473:pathology* / Q000601:surgery; D011237:Predictive Value of Tests; D015203:Reproducibility of Results; D012878:Skin Neoplasms / Q000473:pathology* / Q000601:surgery