'Rule Out Melanoma' Terminology Has Low Positive Predictive Value for Melanoma Diagnosis
Only 13.41 percent of biopsies labeled ROM were histologically confirmed as melanoma, most of which were melanoma in situ
By Dermsquared Editorial Team | October 13, 2025
WEDNESDAY, Oct. 1, 2025 (HealthDay News) -- The use of "rule out melanoma" (ROM) terminology on pathology requisitions has low positive predictive value for histopathologic diagnosis of melanoma, according to a study published in the September issue of SKIN.
Nathan Shen, M.D., from the Hurley Medical Center in Flint, Michigan, and colleagues conducted a retrospective observational study involving 12,852 skin biopsy specimens to examine the diagnostic yield and histopathologic outcomes of skin biopsies labeled ROM.
The researchers found that 13.41 percent of the biopsies labeled ROM were histologically confirmed as melanoma. Most (74.4 percent) of the confirmed melanoma cases were melanoma in situ, followed by malignant melanoma and metastatic melanoma (18.5 and 7.1 percent, respectively). Dysplastic nevi and seborrheic keratoses were the most common among nonmelanoma diagnoses (24.8 and 18.9 percent, respectively). There was significant variation observed in diagnostic accuracy by provider specialty, with the highest melanoma detection rate for medical doctors, followed by nurse practitioners, doctors of osteopathic medicine, and physician assistants (15.77, 11.34, 10.79, and 8.67 percent, respectively).
"Standardized requisition practices and targeted provider education may help optimize diagnostic accuracy and increase the positive predictive value when providers ask to ROM," the authors write.