Diagnosing melanoma: how do we assess how good we are?

Abstract

The NNT and B:M ratios from our study compare favourably with those in the published literature. The fall in the MM:MMIS and B:M ratios over this 5-year study appears to be an indicator of the ability to detect early disease and is probably secondary to the changes to our skin cancer service. This study may encourage physicians to aim not only for low B:M ratios but also low MM:MMIS ratios.

Successful melanoma triage by a virtual lesion clinic (teledermatoscopy)

“…Only 24% of excised lesions were histologically benign, with NNE for all skin cancers of 1 : 32. MM : MMIS ratio of 1.09 is low, indicating a high sensitivity for diagnosis of melanoma compared to face‐to‐face clinics …”

“…MM : MMIS ratio of 1.09 is low, indicating a high sensitivity for diagnosis of melanoma compared to face-to-face clinics. 10 The main limitation of the study is the reliance on two dermatologists very experienced in teledermatoscopy, increasing the accuracy of the diagnosis. As all patients with suspected melanomas were included in the study, the lack of a control group is less significant.…”

“…9 Expert dermatoscopy may also detect disease at an earlier stage than by naked eye evaluation alone, as assessed by invasive melanoma to melanoma in situ ratio (MM : MMIS). 10 Dermatoscopic images can be viewed at a later point in time and at remote locations (teledermatoscopy), and multiple opinions can be obtained. Teledermatoscopy can reduce the need for a face-to-face consultation and provides patients with quicker, local and less time consuming access to specialists.…”

Misdiagnosis of Melanoma: A 7 Year Single-Center Analysis

“…As pointed out in a study by Esdaile et al, physicians should be aware that the ratio between benign and malignant lesions is low, as is the ratio between invasive malignant melanoma and melanoma in situ [9]. These two ratios should be used in combination as an indicator of diagnostic accuracy in detecting melanoma.…”

Lack of harms from community‐based melanoma screening by primary care providers

“…An additional consideration when measuring the consequences of CM screening relates to the cost of diagnosing melanoma and the associated number of lesions that are needed to be evaluated histologically to identify CM cases at early stages (number needed to treat [NNT]). Depending on the study, and in particular the level of provider diagnostic expertise, the rate can vary from 3 to 28 biopsies or excisions to identify 1 case of CM . However, even in the worst‐case scenario, if one uses a high NNT of 30, the estimated cost would be approximately $10,500 per melanoma diagnosis, which still represents <10% of current costs for metastatic disease therapy …”