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Journal of the American Academy of Dermatology
Sous presse. Epreuves corrigées par l'auteur. Disponible en ligne depuis le jeudi 6 février 2020
Doi : 10.1016/j.jaad.2019.12.063
accepted : 22 December 2019
Meta-analysis of number needed to treat for diagnosis of melanoma by clinical setting

Amy J. Petty, BS a, Bradley Ackerson, MD b, Reed Garza, MD c, Michael Peterson, MD d, Beiyu Liu, PhD e, Cynthia Green, PhD e, Michelle Pavlis, MD f,
a School of Medicine, Duke University, Durham, North Carolina 
b Department of Radiation Oncology, Duke University, Durham, North Carolina 
c Revere Health, Provo, Utah 
d Department of Radiology, University of Utah, Salt Lake City, Utah 
e Department of Biostatistics and Bioinformatics, Duke University, Durham, North Carolina 
f Department of Dermatology, Duke University, Durham, North Carolina 

Correspondence to: Michelle Pavlis, MD, Address: 5324 McFarland Dr, Ste 210, Durham, NC 27707.Address: 5324 McFarland Dr, Ste 210DurhamNC27707

To provide a formal statistical comparison of the efficacy of melanoma detection among different clinical settings.


A systematic review and meta-analysis of all relevant observational studies on number needed to treat (NNT) in relation to melanoma was performed in MEDLINE. We performed a random-effects model meta-analysis and reported NNTs with 95% confidence intervals (CIs). The subgroup analysis was related to clinical setting.


In all, 29 articles including a total of 398,549 biopsies/excisions were analyzed. The overall NNT was 9.71 (95% CI, 7.72-12.29): 22.62 (95% CI, 12.95-40.10) for primary care, 9.60 (95% CI, 6.97-13.41) for dermatology, and 5.85 (95% CI, 4.24-8.27) for pigmented lesion specialists.


There is heterogeneity in data reporting and the possibility of missing studies. In addition, the incidence of melanoma varies among clinical settings, which could affect NNT calculations.


Pigmented lesion specialists have the lowest NNT, followed by dermatologists, suggesting that involving specialists in the diagnosis and treatment of pigmented skin lesions can likely improve patient outcomes.

The full text of this article is available in PDF format.

Key words : dermatologic surgery, melanoma, melanoma in situ, number needed to excise, number needed to treat, oncology, pigmented lesions

Abbreviations used : CI, NNT, REM, SK

 Funding sources: Supported by the National Center for Advancing Translational Sciences of the National Institutes of Health under award number UL1TR002553. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.
 Conflicts of interest: None disclosed.
 IRB approval status: Reviewed and approved by Duke University IRB (approval #0007909).
 Reprints not available from the authors.

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© 2020  Published by Elsevier Masson SAS.
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