Factors for Improving Diagnosis of Skin Tumors

Abstract

Background: Although several studies have investigated the accuracy of clinical diagnoses of skin tumors, specific ways to improve diagnostic accuracy have not been identified. This study investigated factors that influence the accuracy of clinical skin tumor diagnostic methods and discusses strategies to improve accuracy.

Methods: Study 1 retrospectively analyzed 657 skin tumors excised at our hospital between March 2001 and March 2011. Data were extracted from surgical records to establish a diagnostic template for further research. Study 2 prospectively applied this template to aid clinical diagnosis at four facilities between April 2011 and March 2013. The clinical diagnoses were compared with the histological ones and the concordance was determined.

Results: A total of 448 and 209 benign and malignant tumors, respectively, were included in Study 1. The overall diagnostic accuracy was 79.0%. In Study 2, 310 patients were clinically diagnosed using a standardized template, which did not affect the diagnostic accuracy. Age, sex, duration of disease, tumor size and location, skin tone, mobility, stiffness, and years of diagnostic experience did not significantly affect diagnostic accuracy. A high proportion of pathologically malignant tumors were clinically misdiagnosed as benign (16/22; 72%). Other clinical examinations were performed in only 35 cases.

Conclusions: Auxiliary diagnostic tools such as dermoscopy and biopsies should be used to accurately diagnose malignant tumors.

Keywords: accuracy; misdiagnosis; skin tumor.