Dermatologists use knowledge of patterns to recogniz...( ure the patient 1199 (29.7 percent) ...),Health

ure the patient", 1,199 (29.7 percent) because the dermatologist considered them suspicious and 869 (21.5 percent) because the dermatologist thought they might be precursors to melanoma. These different reasons accounted for two (1.3 percent), nine (6.0 percent), 141 (94.6 percent) and 14 (9.4 percent) of the 149 lesions that were determined to be melanoma.

"Among the different perceptions of a lesion by a dermatologist, those most relevant to making an accurate diagnosis of MM [melanoma] seem to be the feeling that this lesion is overall irregular by reference to the usual nevi [moles and beauty marks], the perception of an ugly duckling sign by reference to the other nevi in the subject, and, to a lesser degree, the knowledge that the lesion has recently changed," the authors write.

"The overall recognition process, mimicking experts in their daily practice, could be useful in the field of education at MM detection," the authors state. "Indeed a learning process with photographs, based on a global cognitive approach, is worth being assessed. Our study also confirms how much a recent change is important for a reliable diagnosis of MM. In this regard, the fact that an MM was found in nine (1.68 percent) of the 535 nevi that were removed only to reassure the patient should lead physicians to listen carefully to patients who want a mole resected [removed], because patients may perceive subtle changes that they may be unable to communicate."

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Contact: Jean Jacques Grob, M.D.
jgrob@mail.ap-hm.fr
JAMA and Archives Journals
18-Apr-2005

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