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Sensitivity and Specificity of Malignant Melanoma, Squamous Cell Carcinoma, and Basal Cell Carcinoma in a General Dermatological Practice

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dc.contributor.advisor Abell, Troy
dc.contributor.author Taylor, Rachel
dc.date.copyright 2012
dc.identifier.uri http://hdl.handle.net/2104/8317
dc.description.abstract Introduction. Incidence of melanoma and non-melanoma skin cancer is increasing worldwide. Melanoma is the sixth most common cancer in the United States, making skin cancer a significant public health issue. Background and goal. The goal of this study was to provide estimates for sensitivity (P(T+|D+)), specificity (P(T-|D-)), and likelihood ratios (P(T+|D+)/P(T+|D-)) for a positive test and (P(T-|D+)/P(T-|D-)) for negative test of clinical diagnosis compared with pathology reports for malignant melanoma (MM), squamous cell carcinoma (SCC) , basal cell carcinoma (BCC), and benign lesions. This retrospective cohort study collected data on 595 patients with 2,973 lesions in a Central Texas dermatology clinic, randomly selecting patients seen by the dermatology clinic between 1995 and 2011. The ascertation of disease was documented on the pathology report and served as the “gold standard.” Hypotheses. Major hypotheses were that the percentage of agreement beyond that expected by chance between the clinicians’ diagnosis and the pathological gold standard were 0.10, 0.10, 0.30, and 0.40 for MM, SCC, BCC and benign lesions respectively. Results. For MM, the resulting estimates were: (a) 0.1739 (95% C.I. 0.0495, 0.3878), for sensitivity; (b) 0.9952 (95% C.I. 0.9920, 0.9974) for specificity; and (c) the likelihood ratios for a positive and negative test result were 36.23 and 0.83, respectively. For SCC, the resulting estimates were (a) 0.0833 (95% C.I. 0.0312, 0.1726) for sensitivity; (b) 0.9976 (95% C.I. 0.9950, 0.9990); and (c) the likelihood ratios for a positive and negative test result were 34.71 and 0.92, respectively. For BCC, the resulting estimates were: (a) 0.2178 (95% C.I. 0.1630, 0.2812) for sensitivity; (b) 0.9910 (95% C.I. 0.9867, 0.9941) for specificity; and (c) the likelihood ratios for a positive and negative test result were 24.20 and 0.79, respectively. For benign lesions, the resulting estimates were (a) 0.4942 (95% C.I. 0.4715, 0.5169) for sensitivity; (b) 0.9305 (95% C.I. 0.9135, 0.9450) for specificity; and (c) the likelihood ratios for a positive and negative test result were 7.11 and 0.54, respectively. Estimates for the kappa statistic (95% confidence intervals) were 0.1896 (0.0261, 0.3532), 0.1898 (0.0899, 0.2896), 0.3308 (0.2608, 0.3532), and 0.3585 (0.3319, 0.3850) for MM, SCC, BCC, and benign lesions, respectively. Conclusions. Over-biopsying lesions and fear of missing malignancy have a significant impact on the sensitivity and specificity of clinical diagnosis, leading to lowered accuracy. These results challenge clinicians to continue to work toward improving their diagnostic skills concerning MM, SCC, BCC, and benign lesions. en_US
dc.rights Baylor University projects are protected by copyright. They may be viewed from this source for any purpose, but reproduction or distribution in any format is prohibited without written permission. Contact libraryquestions@baylor.edu for inquiries about permission. en_US
dc.subject Dermatology. en_US
dc.subject Skin Cancer. en_US
dc.subject Clinical diagnostic accuracy. en_US
dc.subject Medicine. en_US
dc.subject Epidemiology. en_US
dc.title Sensitivity and Specificity of Malignant Melanoma, Squamous Cell Carcinoma, and Basal Cell Carcinoma in a General Dermatological Practice en_US
dc.type Thesis en_US
dc.rights.accessrights No access - Contact librarywebmaster@baylor.edu en_US
dc.contributor.department Other en_US
dc.contributor.schools honors college en_US


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