Diagnostic Yield of Skin Biopsies Submitted to Rule out Melanoma
Main Article Content
Keywords
Rule out melanoma, Diagnostic Yield, Positive Predicitve Value, Dermatopathology
Abstract
Background: The phrase “rule out melanoma” (ROM) frequently appears on pathology requisitions, potentially influencing diagnostic thresholds and clinical management. Despite widespread use, the diagnostic yield and implications of ROM terminology remain under-investigated.
Objective: To assess the diagnostic yield and histopathologic outcomes of skin biopsies labeled ROM, and evaluate differences in melanoma detection accuracy across healthcare provider types.
Methods: In this retrospective observational study, we analyzed 12,852 skin biopsy specimens submitted to Cockerell Dermatopathology during 2024 with requisitions explicitly containing ROM language. Diagnostic yields, melanoma subtypes, and alternative diagnoses were documented. Provider-specific diagnostic accuracy was compared using Chi-squared and Fisher’s exact tests.
Results: Of 12,852 biopsies labeled to ROM, 1,724 (13.41%) were histologically confirmed as melanoma. Melanoma in situ accounted for the majority (74.4%) of confirmed melanoma cases, followed by malignant melanoma (18.5%) and metastatic melanoma (7.1%). Among non-melanoma diagnoses, dysplastic nevi (24.8%) and seborrheic keratoses (18.9%) were the most common. Diagnostic accuracy varied significantly by provider specialty (p < 0.001), with medical doctors exhibiting the highest melanoma detection rate (15.77%), followed by nurse practitioners (11.34%), Doctor of Osteopathic Medicine (10.79%), and physician assistants (8.67%).
Conclusion: ROM terminology demonstrates low positive predictive value. Significant variability in melanoma detection rates across provider types suggests the potential for improved clinical decision-making and requisition practices to minimize overdiagnosis and diagnostic burden.
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