Referral pattern and accuracy of clinical diagnosis of cutaneous melanoma

Between 1981 and 1983, 329 patients with cutaneous melanoma registered in Amsterdam and Rotterdam, The Netherlands, were analysed with respect to the referral pattern and accuracy of clinical diagnosis. With increasing Breslow thickness, a greater proportion of the patients were referred to the surgeon than to the dermatologist (p less than 0.01). The overall clinical suspicion rate was 61.6%. Suspicion of melanoma was greater for lesions less than or equal to 2 mm thick vis-à-vis the greater than 2 mm thickness group (p less than 0.01). Accuracy of clinical diagnosis was better for dermatologists than for surgeons (p less than 0.01, after adjustment for microstage). Differential diagnoses were more often considered by dermatologists than by surgeons (p less than 0.01). Vague descriptions such as 'tumour' without specification were less frequently used by dermatologists than by surgeons (p less than 0.01). Amelanotic melanomas were often missed clinically by both disciplines (overall diagnostic accuracy 28.6%). It is emphasized that close cooperation between dermatologists and surgeons in the clinical management of melanoma is highly desirable.