0
We're unable to sign you in at this time. Please try again in a few minutes.
Retry
We were able to sign you in, but your subscription(s) could not be found. Please try again in a few minutes.
Retry
There may be a problem with your account. Please contact the AMA Service Center to resolve this issue.
Contact the AMA Service Center:
Telephone: 1 (800) 262-2350 or 1 (312) 670-7827  *   Email: subscriptions@jamanetwork.com
Error Message ......
The Rational Clinical Examination |

Does This Patient Have a Mole or a Melanoma?

John D. Whited, MD; James M. Grichnik, MD, PhD
JAMA. 1998;279(9):696-701. doi:10.1001/jama.279.9.696.
Text Size: A A A
Published online

Lifetime risk for malignant melanoma has increased from 1 in 1500 in the United States in 1930 to 1 in 75 projected for the year 2000. Because the tumor's thickness at excision is the primary prognostic determinant, early detection through the history and physical examination can play an important role in the patient's clinical course. Two checklists have been developed as diagnostic aids, the ABCD (A indicates asymmetry; B, border irregularity; C, irregular color; and D, diameter >6 mm) and the revised 7-point checklists. These checklists should be interpreted with some discretion, but 2 studies have found the sensitivity for the ABCD checklist to be 92% (95% confidence interval [CI], 82%-96%) and 100% (95% CI, 54%-100%); 1 study found the specificity to be 98% (95% CI, 95%-99%). The revised 7-point checklist has been reported to have a sensitivity of 79% (95% CI, 70%-85%) to 100% (95% CI, 94%-100%) and specificity of 30% (95% CI, 21%-39%) to 37% (95% CI, 28%-46%). Physicians' global assessments for detecting the presence or absence of melanoma are estimated to have a specificity of 96% to 99%, while sensitivity ranges widely from 50% to 97%. Nondermatologists' examinations appear to be less sensitive than examinations performed by dermatologists.

Topics

melanoma ; nevus

Sign in

Create a free personal account to sign up for alerts, share articles, and more.

Purchase Options

• Buy this article
• Subscribe to the journal

First Page Preview

View Large
First page PDF preview

Figures

Tables

References

CME
Also Meets CME requirements for:
Browse CME for all U.S. States
Accreditation Information
The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
Your answers have been saved for later.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
Commitment to Change (optional):
Indicate what change(s) you will implement in your practice, if any, based on this CME course.
Your quiz results:
The filled radio buttons indicate your responses. The preferred responses are highlighted
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.

Multimedia

Some tools below are only available to our subscribers or users with an online account.

Web of Science® Times Cited: 57

Sign in

Create a free personal account to sign up for alerts, share articles, and more.

Purchase Options

• Buy this article
• Subscribe to the journal

Related Content

Customize your page view by dragging & repositioning the boxes below.

See Also...
Articles Related By Topic
Related Collections
PubMed Articles
Jobs
JAMAevidence.com

Users' Guides to the Medical Literature
Melanoma

The Rational Clinical Examination
Make the Diagnosis: Melanoma

brightcove.createExperiences();