title: Diagnosing malignant melanoma in ambulatory care: a systematic review of clinical prediction rules.
abstract: Malignant melanoma has high morbidity and mortality rates. Early diagnosis improves prognosis. Clinical prediction rules (CPRs) can be used to stratify patients with symptoms of suspected malignant melanoma to improve early diagnosis. We conducted a systematic review of CPRs for melanoma diagnosis in ambulatory care.
  
  
  
  Systematic review.
  
  
  
  A comprehensive search of PubMed, EMBASE, PROSPERO, CINAHL, the Cochrane Library and SCOPUS was conducted in May 2015, using combinations of keywords and medical subject headings (MeSH) terms.
  
  
  
  Studies deriving and validating, validating or assessing the impact of a CPR for predicting melanoma diagnosis in ambulatory care were included. Data extraction and methodological quality assessment were guided by the CHARMS checklist.
  
  
  
  From 16 334 studies reviewed, 51 were included, validating the performance of 24 unique CPRs. Three impact analysis studies were identified. Five studies were set in primary care. The most commonly evaluated CPRs were the ABCD, more than one or uneven distribution of Colour, or a large (greater than 6 mm) Diameter (ABCD) dermoscopy rule (at a cut-point of >4.75; 8 studies; pooled sensitivity 0.85, 95% CI 0.73 to 0.93, specificity 0.72, 95% CI 0.65 to 0.78) and the 7-point dermoscopy checklist (at a cut-point of ≥1 recommending ruling in melanoma; 11 studies; pooled sensitivity 0.77, 95% CI 0.61 to 0.88, specificity 0.80, 95% CI 0.59 to 0.92). The methodological quality of studies varied.
  
  
  
  At their recommended cut-points, the ABCD dermoscopy rule is more useful for ruling out melanoma than the 7-point dermoscopy checklist. A focus on impact analysis will help translate melanoma risk prediction rules into useful tools for clinical practice.
authors.affiliation: HRB Centre for Primary Care Research, Royal College of Surgeons in Ireland, Dublin 2, Ireland.
authors.forename: Emma
authors.initials: E
authors.lastname: Harrington
authors.affiliation: HRB Centre for Primary Care Research, Royal College of Surgeons in Ireland, Dublin 2, Ireland.
authors.forename: Barbara
authors.initials: B
authors.lastname: Clyne
authors.affiliation: Medical School, Radboud University, Nijmegen, Netherlands.
authors.forename: Nieneke
authors.initials: N
authors.lastname: Wesseling
authors.affiliation: HRB Centre for Primary Care Research, Royal College of Surgeons in Ireland, Dublin 2, Ireland.
authors.forename: Harkiran
authors.initials: H
authors.lastname: Sandhu
authors.affiliation: HRB Centre for Primary Care Research, Royal College of Surgeons in Ireland, Dublin 2, Ireland.
authors.forename: Laura
authors.initials: L
authors.lastname: Armstrong
authors.affiliation: HRB Centre for Primary Care Research, Royal College of Surgeons in Ireland, Dublin 2, Ireland.
authors.forename: Holly
authors.initials: H
authors.lastname: Bennett
authors.affiliation: HRB Centre for Primary Care Research, Royal College of Surgeons in Ireland, Dublin 2, Ireland.
authors.forename: Tom
authors.initials: T
authors.lastname: Fahey
mesh_terms: D000553:Ambulatory Care / Q000379:methods*; D003661:Decision Support Techniques; D006801:Humans; D008545:Melanoma / Q000175:diagnosis*; D012680:Sensitivity and Specificity
keywords: Clinical prediction rules; Melanoma; PRIMARY CARE; Systematic review