Prospective Study of the Accuracy of the Surgeon's Diagnosis in 2000 Excised Skin Tumors

Abstract

Expeditious yet efficacious removal of skin tumors is a common responsibility for the plastic surgeon. The need to minimize potential risks for mortality or morbidity from undue or excessive surgical resections and to control costs by avoiding unnecessary procedures behooves us to make a precise clinical diagnosis preceding any decision even for such "minor" surgery. Just how accurate these decisions can be expected to be for a typical surgical practice was scrutinized by means of this prospective 4-year study involving the resection of 2058 skin lesions. Each lesion was initially assigned a clinical diagnosis after a brief gross examination and then compared with the pathology report, which was always considered to be the correct answer. Within these parameters, only 65 percent of all tumors were identified correctly preoperatively. Two-thirds of all lesions were benign. Three-quarters of benign lesions were as assumed, and 92 percent of all presumed benign lesions were benign even if incorrectly identified initially, whereas fortunately only 3 percent proved to be malignant. On the other hand, only three-fifths of malignant lesions were identified correctly clinically, yet only 11 percent were benign, implying that most such lesions properly deserved excision anyway. Therefore, approximately 90 percent of all lesions whether benign or malignant were removed appropriately without compromising the patient, but to expect a clinical acumen of 100 percent in this setting may not be realistic. The accuracy of the surgeon in identifying lesions as probably benign was certainly high enough that cost-containment mechanisms designed to deny authorization for their removal probably would be justifiable and difficult to appeal. Any suspicious or equivocal lesions still will require mandatory intervention despite such constraints, because often only histologic examination will allow a definitive diagnosis.

Evaluation of The Diagnosis and Treatment of Non-Melanoma Skin Cancer and its Impacts on The Prevention Habits in a Specific Population of Southeastern Brazil

“…The diagnostic accuracy presented in this study is within the variation observed in the literature for both BCC and SCC. In other studies, on the contrary of ours, the diagnostic accuracy for BCC is higher than for SCC (7,21,22).…”

“…Another important aspect is that high rates of false negatives and false positives can not be ignored (7). In this study, ten diagnoses were false-positive, accounting for 23.8% of the total formulated diagnostic hypotheses, what is below the percentages reported in other studies (22,25) that reported that up to 40% of the cases of suspected malignant lesions may, indeed, be benign lesions (22). There are reports (25) in which skin lesions clinically diagnosed as BCC, after the pathological examination, were revealed as actinic keratosis (7.5%), Bowen's disease (6.4%) and SCC (5.7%); and that the suspicious SCC lesions were actually actinic keratosis (11.1%), Bowen's disease (3.1%) and BCC (43%) (25).…”

“…In a previous paper (23), dermatologists accurately diagnosed 59% and 39% cases of BCC and SCC, respectively. In another study (22), a plastic surgeon accurately diagnosed 70% of BCC and 25% of SCC.…”

“…Incisional biopsy of the lesion, for suspicion of both BCC and SCC is indicated when there is diagnostic uncertainty (8,9); it can be time consuming, costly and sometimes crippling and painful for the patient, not being justified in most cases (7). The accuracy of the NMSC clinical diagnosis is approximately 60.2% (20); in relation to BCC it ranges from 59% to 88.93% (18,(20)(21)(22)(23) and for SCC it ranges from 25% to 67.4% (18,(20)(21)(22)(23). The diagnostic accuracy presented in this study is within the variation observed in the literature for both BCC and SCC.…”

Evaluation of the Cases Who Were Referred to Plastic Surgery Clinic Out of Suspicion of Non-melanoma Skin Cancer Localized at Head and Neck Region in Sivas Numune Hospital

“…21 Yapılan bir çalışmada, sadece klinik muayene ile yapılan benign-malign ayrımında; benign yerine yanlış malign tanısı konulma yüzdesi %3 olarak bildirilirken, malign lezyonların %40 oranında yanlış benign tanısı aldığı belirtilmiştir. 22 Yapılan gözden geçirme çalışmaları sonucunda fizik muayenenin NMCK tanısı konulmasındaki sensitivitesi %56-90 arasında tespit edilmiş olup, aradaki bu fark klinisyenin tecrübesine bağlıdır. 23 Klinik incelemenin sensitivitesi bazal hücreli karsinomların tanısında %75-90'a kadar çıkmaktadır.…”