Cassileth B R, Clark W H, Lusk E J, Frederick B E, Thompson C J, Walsh W P
J Am Acad Dermatol. 1986 Apr;14(4):555-60. doi: 10.1016/s0190-9622(86)70068-6.
The alarming increase in the incidence of cutaneous malignant melanoma in the United States emphasizes the importance of its early detection and treatment. Early detection requires accurate clinical recognition of both malignant and precancerous skin lesions (dysplastic nevi). This study presents data on dermatologists' and nondermatologists' ability to diagnose skin lesions. A total of 105 nondermatologist physicians, from first-year residents to practicing physicians, and forty-eight dermatologists were asked to identify color slides or photographs of eleven cutaneous lesions, including malignant melanomas, dysplastic nevi, and innocuous lesions such as seborrheic keratoses and common moles. Diagnosis of cutaneous lesions was generally inaccurate among nondermatologists. Only 38% correctly identified four or more of the six melanomas as melanoma of any type, and 58% were unable to diagnose dysplastic nevi. Only 17% categorized their relevant training as excellent or good. Improved training in the diagnosis of skin lesions for practicing physicians and house staff is required if mortality from malignant melanoma is to be decreased in the United States.
美国皮肤恶性黑色素瘤发病率的惊人增长凸显了早期发现和治疗的重要性。早期发现需要对恶性和癌前皮肤病变（发育异常痣）进行准确的临床识别。本研究展示了皮肤科医生和非皮肤科医生诊断皮肤病变能力的数据。共有105名非皮肤科医生，从一年级住院医师到执业医师，以及48名皮肤科医生被要求识别11种皮肤病变的彩色幻灯片或照片，包括恶性黑色素瘤、发育异常痣以及诸如脂溢性角化病和普通痣等无害病变。非皮肤科医生对皮肤病变的诊断通常不准确。只有38%的人能正确将六种黑色素瘤中的四种或更多诊断为任何类型的黑色素瘤，58%的人无法诊断发育异常痣。只有17%的人将他们的相关培训评为优秀或良好。如果要在美国降低恶性黑色素瘤的死亡率，就需要对执业医师和住院医生进行改进的皮肤病变诊断培训。
