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Diagnostic accuracy for ocular malignant melanoma has significantly improved, with incorrect diagnoses dropping from 12.5% to 1.4% over an 11-year period. This suggests enhanced clinical expertise outside major academic centers.

Area of Science:

Ophthalmology
Pathology
Oncology

Background:

Malignant melanoma of the eye is a serious diagnosis.
Previous studies at the Armed Forces Institute of Pathology (AFIP) identified rates of incorrect diagnoses.
Changes in diagnostic accuracy over time were not well-established.

Purpose of the Study:

To evaluate changes in the frequency of incorrect diagnoses of ocular malignant melanoma.
To compare current diagnostic accuracy with historical data from the AFIP.
To identify trends in diagnostic accuracy among clinicians.

Main Methods:

Retrospective review of 6,169 whole eye submissions to the AFIP (1970-1980).
Analysis of 744 cases with clear media and a clinical diagnosis of malignant melanoma.

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Calculation of the rate of incorrect diagnoses and comparison across study periods.

Main Results:

The overall rate of incorrect diagnosis for ocular malignant melanoma was 6.4% (48/744 cases).
A significant decline in incorrect diagnoses was observed, decreasing from 12.5% in earlier periods to 1.4% by the end of the study.
The frequency and location of lesions simulating malignant melanoma remained consistent with previous findings.

Conclusions:

There has been a substantial improvement in the diagnostic accuracy of ocular malignant melanoma.
The findings suggest increased diagnostic competence among clinicians, particularly those outside major academic institutions.
Continued vigilance for simulating lesions is warranted despite improved accuracy.