Melanoma staging: Varying precision and terminal digit clustering in Breslow thickness data is evident in a population-based study

Abstract

Errors in Breslow thickness reporting can give misclassification of T category, an important classifier in melanoma staging. We sought to investigate precision (number of digits) and terminal digit clustering in Breslow thickness and potential consequences for T category. All first primary and morphologically verified invasive melanomas in Norway between 2008 and 2015 were included. A smoothing model was fitted to estimate the underlying Breslow thickness distribution without digit clustering. Thickness was reported for 13,057 (97.5%) patients; the median was 1.0mm (range, 0.09-85). It was reported as whole numbers (15.6%), to 1 decimal (78.2%) and 2 decimal places (6.2%)-thin tumors with more precision than thick tumors. Terminal digit clustering was found with marked peaks in the observed frequency distribution for terminal digits 0 and 5, and with drops around these peaks. Terminal digit clustering increased proportions of patients classified with T1 and T4 tumors and decreased proportions classified with T2 and T3. Breslow thickness was not reported in 2.5% of cases. The Norwegian recommendation of measurement to the nearest 0.1mm was not followed. Terminal digit clustering was marked, with consequences for T category. Pathologists, clinicians, and epidemiologists should know that clustering of thickness data around T category cut points can impact melanoma staging with consequent effect on patient management and prognosis.