[Diagnostic accuracy of skin lesions excised by a plastic surgeon].

BACKGROUND: Skin tumors are the most common malignancies in the western population, with surgical excision as the definitive treatment. OBJECTIVES: The author's objectives were to estimate the precision of clinical diagnosis of skin tumors by a plastic surgeon in a community clinic. METHODS: The study includes clinical and histological data of patients operated on solely by one plastic surgeon, between November 2001 to July 2003. The sensitivity and positive predictive value were measured and compared to the literature. RESULTS: The study included 1640 patients. Out of 1806 excised skin lesions, 17.4% were malignancies. Basal cell carcinoma was the most common tumor, followed by squamous cell carcinomas and melanomas. Sensitivity for skin malignancy was 94%, and 76.5% for specific skin malignancy. Positive predictable value for any malignancy was 69.4%, and 72% for the basal cell carcinoma, the most common skin malignancy. CONCLUSIONS: Clinical examination is the main diagnostic tool for the plastic surgeon and dermatologist in the evaluation of skin lesions. Surgical excision is considered when clinical diagnosis is not productive or when malignancy is suspected. For most malignancies, diagnostic excision is therapeutic as well. Positive predictable value is a prospective index estimating the clinical diagnostic skills of the clinician. In our opinion, new technologies such as dermatoscopy should be used more often in the evaluation of skin lesions.