Clinical diagnostic accuracy in the management of primary Stage I cutaneous malignant melanoma in a plastic surgery unit.

In a retrospective review of 614 primary Stage I cutaneous malignant melanomata and 40 nonmelanoma lesions, the diagnostic accuracy(DA) for malignant melanoma was 86.2%. A positive preoperative clinical diagnosis of malignant melanoma was confirmed histologically in 564/604 (93.3%) of lesions. For 614 histologically proven malignant melanomata a correct pre-operative clinical diagnosis had been made in 564/614 (91.9%). An additional 172 patients were referred for wider excisional surgery within 3 months of a biopsy elsewhere. For the total 786 (614+172) patients, the incidence of biopsy of a clinicially unsuspected (but subsequently histologically proven) malignant melanoma prior to referral to the Plastic Surgery Unit was lowest for lesions of the head and neck (18.3%) and lower limb (19.0%), and highest (almost half of the patients) for lesions of the hands and fingers. Previous reports of the poor level of clinical diagnostic accuracy in cutaneous malignant melanoma have not been confirmed in the present study.