Appropriately trained and experienced histopathologists can assess prognostically important features of melanomas accurately and reproducibly. Given our recent finding of the significance of TMR in determining prognosis, it is important that this feature be assessed by a standardized method and documented for all primary cutaneous melanomas.
A retrospective audit of melanoma clinical diagnoses was undertaken for a group of 35 Australian dermatologists. This was compared with the histological diagnoses. In a 1-year period, 195 of the 686 clinically suspicious lesions were histologically confirmed as melanoma. Therefore, the number needed to treat for histological referrals for melanoma is four for this group of dermatologists. In addition, we found that the sensitivity for the diagnosis of melanoma was 89.1% if we consider all lesions that are possibly clinically suspicious of melanoma. Our results suggest that the clinical diagnosis of melanoma may not be difficult for lesions that are clinically characteristic.
A 50-year-old woman presented with multiple skin-coloured facial papules. There was a family history of similar lesions. Histology of one of these papules was consistent with fibrofolliculoma. Multiple fibrofolliculomas together with flexural acrochordons suggested the diagnosis of Birt-Hogg-Dubé syndrome. Investigations to exclude associated disease revealed changes consistent with multinodular goitre on thyroid ultrasound. The literature regarding the association of Birt-Hogg-Dubé syndrome with internal disease is reviewed.
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