{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,2]],"date-time":"2026-09-02T12:13:06Z","timestamp":1788351186050,"version":"build-2803163510"},"reference-count":21,"publisher":"MDPI AG","issue":"9","license":[{"start":{"date-parts":[[2026,8,28]],"date-time":"2026-08-28T00:00:00Z","timestamp":1787875200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Medicina"],"abstract":"<jats:p>Background and Objectives: Deciding which pigmented or non-pigmented skin lesions require surgical excision, as opposed to continued observation, is a common challenge in everyday dermatologic practice. Although dermoscopy is well established as a tool that improves melanoma detection accuracy compared with naked-eye examination, real-world evidence on how demographic profile, patient history, and dermoscopic impression jointly influence the surgical decision remains limited. This study examined the clinical and dermoscopic factors associated with a positive surgical decision (PSD) in a large single-centre screening cohort. Materials and Methods: This retrospective cross-sectional analysis included 643 consecutive patients (415 female (64.5%), 228 male (35.5%); mean age 51.3 \u00b1 16.8 years) undergoing dermoscopic skin cancer screening. Data recorded included family history of melanoma (FHM), personal history of skin cancer (HSC), childhood sunburn (CS), clinically atypical lesions (CAL), suspicion of basal\/squamous cell carcinoma (BCC\/SCC), nevus count (NC, 0\u20134), and the surgical decision (PSD). Free-text dermoscopic descriptions were grouped into seven diagnostic categories. Group comparisons used the Mann\u2013Whitney U, \u03c72, and Fisher\u2019s exact tests; predictors of PSD were characterised using multivariable logistic regression (with Hosmer\u2013Lemeshow and Nagelkerke R2 statistics), multiple correspondence analysis (MCA), Gower-distance k-medoids clustering, and receiver operating characteristic (ROC) analysis, including the area under the curve (AUC). Missing NC data (13.2%) were assessed using Little\u2019s test for data missing completely at random (MCAR test). Results: A positive surgical decision was recorded in 133\/643 patients (20.7%) and was significantly more common in men than women (25.9% vs. 17.9%; p = 0.017; corresponding to an odds ratio (OR) of 1.61). In multivariable analysis, suspicion of BCC\/SCC (OR = 24.7, 95% confidence interval (CI): 9.26\u201366.0) and clinically atypical lesions (OR = 5.53, 95% CI 3.50\u20138.74) were the strongest independent predictors of PSD (Nagelkerke R2 = 0.31; Hosmer\u2013Lemeshow p = 0.977), far outweighing family or personal history. A significant interaction between childhood sunburn and nevus count (OR = 1.39, 95% CI 1.16\u20131.66; p &lt; 0.001) predicted clinical atypia. Missing NC data were consistent with a completely random pattern (Little\u2019s \u03c72 = 2.80, df = 2, p = 0.247). Dermoscopic impression showed strong discriminative value for PSD: \u201cno concern\u201d had the highest negative predictive value (NPV = 0.927; AUC = 0.762), while \u201catypical lesion\u201d combined high specificity (0.916) and positive predictive value (0.632; AUC = 0.736). On average, 4.8 patients were examined for every surgical referral generated (a screening-to-referral ratio, not a number needed to screen for a histologically confirmed cancer). Conclusions: Surgical decision-making in this cohort was driven almost exclusively by the dermoscopic impression\u2014suspected BCC\/SCC and clinical atypia\u2014rather than by family or personal oncological history, while male sex was independently associated with a higher surgical rate. These findings support dermoscopy-led triage protocols and highlight the potential value of standardised risk stratification to optimise referral pathways in routine skin cancer screening.<\/jats:p>","DOI":"10.3390\/medicina62091655","type":"journal-article","created":{"date-parts":[[2026,8,28]],"date-time":"2026-08-28T18:33:52Z","timestamp":1787942032000},"page":"1655","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Clinical and Dermoscopic Determinants of Surgical Decision-Making in Skin Cancer Screening: A Retrospective Analysis"],"prefix":"10.3390","volume":"62","author":[{"given":"Adrian","family":"Chwojnicki","sequence":"first","affiliation":[{"name":"Department of Dermato-Venereology, 4th Military Clinical Hospital, 50-981 Wroclaw, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sebastian","family":"Makuch","sequence":"additional","affiliation":[{"name":"Department of Clinical and Experimental Pathology, Wroclaw Medical University, 50-368 Wroclaw, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hanna","family":"Adamska","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, Wroclaw University of Science and Technology, 50-370 Wroclaw, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michalina","family":"\u015awietlicka","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, Wroclaw University of Science and Technology, 50-370 Wroclaw, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maja","family":"Hrynczyszyn","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, Wroclaw University of Science and Technology, 50-370 Wroclaw, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Inga","family":"Bu\u0142awa","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, Wroclaw University of Science and Technology, 50-370 Wroclaw, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paulina","family":"Piesch","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, Wroclaw University of Science and Technology, 50-370 Wroclaw, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jacek","family":"Pola\u0144ski","sequence":"additional","affiliation":[{"name":"Department of Internal and Occupational Diseases, Hypertension and Clinical Oncology, Wroclaw Medical University, 50-556 Wroclaw, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wojciech","family":"Ta\u0144ski","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, Wroclaw University of Science and Technology, 50-370 Wroclaw, Poland"},{"name":"Department of Internal Medicine, 4th Military Clinical Hospital, 50-981 Wroclaw, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,8,28]]},"reference":[{"key":"ref_1","first-page":"5484597","article-title":"The Global, Regional, National Burden of Cutaneous Squamous Cell Carcinoma (1990\u20132019) and Predictions to 2035","volume":"2023","author":"Guo","year":"2023","journal-title":"Eur. 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