Clinical Suspicion Sensitivity of Nodular and Superficial Spreading Melanoma
DOI:
https://doi.org/10.2340/00015555-3782Keywords:
melanoma, nodular melanoma, superficial spreading melanoma, suspicion sensitivity, population-based dataAbstract
In Norway, nodular melanoma is the most fatal melanoma subtype and superficial spreading melanoma the most common, indicating diagnostic challenges. The aim of this study was to assess the clinical suspicion sensitivity of nodular melanoma and superficial spreading melanoma, by diagnosing physician, using randomly selected 100 nodular melanomas and 100 superficial spreading melanomas from the Norwegian Melanoma Registry, diagnosed in 2014 to 2015. Information about suggested diagnoses and diagnosing physician was collected from pathology request forms. Suspicion sensitivity was defined as the proportion (%) of cases with “melanoma” as a suggested diagnosis, estimated with 95% confidence interval (95% CI). Most melanomas (74.5%) were diagnosed by non-dermatologists, with a suspicion sensitivity of 23% (95% CI 15–34) for nodular melanoma and 24% (95% CI 16–35) for superficial spreading melanoma. Corresponding estimates for dermatologists were 50% (95% CI 32–68) and 96% (95% CI 80–99), respectively (pinteraction=0.007). The low suspicion sensitivity for both subtypes among non-dermatologists calls for educational efforts.
Downloads
References
Whiteman DC, Green AC, Olsen CM. The growing burden of invasive melanoma: projections of incidence rates and numbers of new cases in six susceptible populations through 2031. J Invest Dermatol 2016; 136: 1161-1171.
DOI: https://doi.org/10.1016/j.jid.2016.01.035
Robsahm TE, Helsing P, Nilssen Y, Vos L, Rizvi SMH, Akslen LA, et al. High mortality due to cutaneous melanoma in Norway: a study of prognostic factors in a nationwide cancer registry. Clin Epidemiol 2018; 10: 537-548.
DOI: https://doi.org/10.2147/CLEP.S151246
Friedman RJ, Rigel DS, Kopf AW. Early detection of malignant melanoma: the role of physician examination and self-examination of the skin. CA Cancer J Clin 1985; 35: 130-151.
DOI: https://doi.org/10.3322/canjclin.35.3.130
Abbasi NR, Shaw HM, Rigel DS, Friedman RJ, McCarthy WH, Osman I, et al. Early diagnosis of cutaneous melanoma: revisiting the ABCD criteria. JAMA 2004; 292: 2771-2776.
DOI: https://doi.org/10.1001/jama.292.22.2771
Robinson JK, Turrisi R. Skills training to learn discrimination of ABCDE criteria by those at risk of developing melanoma. Arch Dermatol 2006; 142: 447-452.
DOI: https://doi.org/10.1001/archderm.142.4.447
Nartey Y, Sneyd MJ. The presenting features of melanoma in New Zealand: implications for earlier detection. Aust N Z J Public Health 2018; 42: 567-571.
DOI: https://doi.org/10.1111/1753-6405.12815
Lin MJ, Mar V, McLean C, Wolfe R, Kelly JW. Diagnostic accuracy of malignant melanoma according to subtype. Australas J Dermatol 2014; 55: 35-42.
DOI: https://doi.org/10.1111/ajd.12121
Martinka J, Crawford RI, Humphrey S. Clinical recognition of melanoma in dermatologists and nondermatologists. J Cutan Med Surg 2016; 20: 532-535.
DOI: https://doi.org/10.1177/1203475415623513
Larsen IK, Smastuen M, Johannesen TB, Langmark F, Parkin DM, Bray F, et al. Data quality at the Cancer Registry of Norway: an overview of comparability, completeness, validity and timeliness. Eur J Cancer 2009; 45: 1218-1231.
DOI: https://doi.org/10.1016/j.ejca.2008.10.037
Cancer Registry of Norway. Cancer in Norway 2018 - cancer incidence, mortality, survival and prevalence in Norway. Oslo: Cancer Registry of Norway, 2019. [cited 2020 May 11]. Available from: https://www.kreftregisteret.no/globalassets/cancer-in-norway/2018/cin2018.pdf.
World Health Organization (WHO). International Classification of Diseases for Oncology, 3rd edn (1st rev). Geneva: WHO, 2013.
Gershenwald JE, Scolyer RA, Hess KR, Sondak VK, Long GV, Ross MI, et al. Melanoma staging: evidence-based changes in the American Joint Committee on Cancer Eighth Edition Cancer Staging Manual. CA Cancer J Clin 2017; 67: 472-492.
DOI: https://doi.org/10.3322/caac.21409
Norwegian Directorate of Health. National Action program with guidelines for diagnosis, treatment and follow-up of malignant melanomas (In Norwegian). [cited 2020 May 11]. Available from: https://www.helsedirektoratet.no/retningslinjer/maligne-melanomer-handlingsprogram.
Hosmer DW, Lemeshow S. Applied logistic regression, 2nd edn. USA: John Wiley & Sons, Inc, 2000.
DOI: https://doi.org/10.1002/0471722146
Lydersen S, Fagerland MW, Laake P. Categorical data and contingency tables. In: Medical statistics in clinical and epidemiological research (Veierød MB, Lydersen S, Laake P, eds). Oslo: Gyldendal Akademisk, 2012: p. 48-89.
Baade P, Meng X, Youlden D, Aitken J, Youl P. Time trends and latitudinal differences in melanoma thickness distribution in Australia, 1990-2006. Int J Cancer 2012; 130: 170-178.
DOI: https://doi.org/10.1002/ijc.25996
Youl PH, Baade PD, Janda M, Del Mar CB, Whiteman DC, Aitken JF. Diagnosing skin cancer in primary care: how do mainstream general practitioners compare with primary care skin cancer clinical doctors? Med J Aust 2007; 187: 215-220.
DOI: https://doi.org/10.5694/j.1326-5377.2007.tb01202.x
Mar VJ, Chamberlain, Kelly JW, Murray WK, Thompson JF. Clinical practice guidelines for the diagnosis and management of melanoma: melanomas that lack classical clinical features. Med J Aust 2017; 207: 348-350.
DOI: https://doi.org/10.5694/mja17.00123
Kirkwood BR, Sterne JAC. Medical Statistics, 2nd edn. Blackwell Science Ltd, Malden, Massachusetts, USA, 2003.
Mar VJ, Roberts H, Wolfe R, English DR, Kelly JW. Nodular melanoma: a distinct clinical entity and the largest contributor to melanoma deaths in Victoria, Australia. J Am Acad Dermatol 2013; 68: 568-575.
Published
How to Cite
License
Copyright (c) 2021 Trude E. Robsahm, Per Helsing, Henrik L. Svendsen
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
All digitalized ActaDV contents is available freely online. The Society for Publication of Acta Dermato-Venereologica owns the copyright for all material published until volume 88 (2008) and as from volume 89 (2009) the journal has been published fully Open Access, meaning the authors retain copyright to their work.
Unless otherwise specified, all Open Access articles are published under CC-BY-NC licences, allowing third parties to copy and redistribute the material in any medium or format and to remix, transform, and build upon the material for non-commercial purposes, provided proper attribution to the original work.
