Melanoma yield, number of biopsies and missed melanomas in a British teaching hospital pigmented lesion clinic: a 9-year retrospective study

Abstract

The demand for pigmented lesion clinics (PLCs) is increasing in view of improved skin cancer awareness following public health education campaigns. These clinics offer an effective way of screening a large number of patients. However, there is no evidence, as yet, that they have an impact on mortality due to malignant melanoma. With the lack of follow-up inherent to these busy screening clinics, there is some concern that melanomas may be missed. This study reports on 7874 patient visits to a PLC in a teaching hospital between 1985 and 1994. In total, 1705 biopsies were performed over the 9-year period. Lesions were more likely to be biopsied in men compared with women. The yield for picking melanomas was one in 36 patient visits. The mean age of patients attending the PLC was 10 years less than the mean age for population-based melanomas. Melanoma thickness did not significantly change over the 9-year period. Only 0.2% of patients (14 cases) re-presented to the PLC for a second or third visit with a final diagnosis of melanoma, but for five of these patients, the interval between the two visits was over 2 years. Most of these 're-attending' melanomas were early lesions. PLCs offer a fast, safe and efficient service for the screening of pigmented lesions but their role in reducing mortality due to malignant melanoma remains to be established. It is likely that these clinics have an important role in terms of public health education regarding sun avoidance and early recognition of skin cancer.

Melanoma screening: results of the first one‐day campaign in Belgium (‘Melanoma Monday’)

“…There were twice as many women as men and the mean age was 35 years. This is comparable with the results in other screening programmes 2 . There was a predominance of phototypes II and III (80%, as in the general Belgian population).…”

Melanoma screening clinics: are we detecting more melanomas or reassuring the worried well?

“…1). These findings are similar to those reported from other U.K. centres 7–9 . The average number of new patients seen at each clinic has risen by 233% over the 8‐year observation period (Table 1).…”

Surgical treatment of melanoma

“…Similarly, melanoma screening days may not be a particularly cost‐effective way of seeing and treating melanoma cases more quickly 21 . The use of targeted referrals to PLCs is likely to be more valuable in the early diagnosis and treatment of melanoma, 22 and the false‐negative rate of diagnosis in PLCs has been shown to be small 23,24 . Furthermore, the use of dermoscopy in PLCs, either on its own 25 or using sophisticated image analysis, 26,27 may make PLCs more efficient and reduce both false‐positive and false‐negative results.…”