Abstract
Background/Aim: The purpose of the study was to assess the effectiveness of diagnostic methods, i.e., clinical evaluation and dermoscopy in the detection of malignant skin neoplasms (MSNs).
Patients and Methods: Between December 2021 and August 2025, 161 skin lesions from 142 patients were analyzed, comparing clinical evaluation (51 cases) with clinical evaluation with dermoscopy (110 cases) for the diagnosis of MSNs, including malignant melanomas of the skin (MMs) and non-melanoma malignant skin neoplasms (NMMSNs).
Results: In comparison to clinical evaluation, clinical evaluation with dermoscopy in the detection of all malignant skin neoplasms (33 cases) increased the sensitivity from 81.8% [95% confidence interval (CI)=52.3-94.9] to 90.9% (95% CI=72.2-97.5), the specificity from 75% (95% CI=59.8-85.8) to 85.2% (95% CI=76.3-91.2), and the diagnostic odds ratio (DOR) from 13.5 (95% CI=2.5-73.2) to 57.7 (95% CI=12-276.8) with the relative diagnostic odds ratio (RDOR)=4.27 (95% CI=0.43-42.9; p=0.217). After adding dermoscopy to clinical evaluation, the sensitivity increased from 80% (95% CI=37.6-96.4) to 92.3% (95% CI=66.7-98.6) in MMs diagnosis (18 cases) and from 83.3% (95% CI=43.6-97) to 88.9% (95% CI=56.5-98) in NMMSNs detection (15 cases). In clinical evaluation with dermoscopy, the DOR increased both in MMs diagnosis from 12 (95% CI=1.2-120.3) to 69.2 (95% CI=8.3-578.7) and in NMMSNs recognition from 15 (95% CI=1.6-144.2) to 46.1 (95% CI=5.3-400.5) with the RDOR 5.77 (95%CI=0.25-132.51; p=0.273) and 3.08 (95%CI=0.13-70.31; p=0.481), respectively.
Conclusion: The sensitivity, specificity, DOR, and RDOR increased with the use of dermoscopy in MSNs diagnosis, mainly in MMs cases. However, the advantage of dermoscopy was not as significant in NMMSNs cases.
Introduction
Malignant skin neoplasms (MSNs), i.e., malignant melanomas of the skin (MMs) and non-melanoma malignant skin neoplasms (NMMSNs), are one of the most common cancers in the world, and their incidence and mortality rates are steadily growing, mainly in regions with white-skinned inhabitants, including Europe. Further increases in MSNs cases are expected in Europe in the coming decades. The two main risk factors for MSNs are population aging and, especially, UV exposure (1, 2). Globally, there were 331,722 new cases and 58,667 deaths from MMs in 2022 (3-5). Europe has the highest incidence and mortality of MMs, with 146,321 new cases (44.1%) and 26,180 deaths (44.6%) annually (4, 5). In Europe, MMs are responsible for more than 80% of MSNs deaths (6). In Poland, there were 4,094 new MMs cases and 1,277 deaths in 2021 (7). In the case of NMMSNs, 70-80% are basal cell carcinomas (BCCs) and 20-25% are squamous cell carcinomas (SCCs). In 2021, the global numbers of new cases were 4,436,939 for BCCs, and 1,899,907 for SCCs (1, 8). In Poland, there were 13,540 new NMMSNs cases and 180 deaths in 2021 (7).
Currently, artificial intelligence-based techniques with computer-aided diagnosis are being used in combination with noninvasive diagnostic imaging methods, including reflectance confocal microscopy, optical coherence tomography, and electrical impedance spectroscopy. However, in practice, MSNs are still routinely diagnosed on the basis of clinical evaluation and dermoscopy (9-17). Several clinical features of MMs have been defined in guidelines, mainly the ABCDE-EFG criteria, recommended by the American Academy of Dermatology Association, and the Glasgow 7-point checklist, recommended by the UK’s National Institute for Health and Care Excellence (NICE) (18-21). There are also well-known clinical features which characterize NMMSNs (22-24).
Dermoscopy, a non-invasive, quick, and safe method for skin lesion diagnosis, has become increasingly useful thanks to technological advances. This is because it can be performed in either a traditional form using a magnifying glass with a light source, or in an electronic form called videodermoscopy. Dermoscopy enables the identification of specific patterns and structures not visible on clinical evaluation, thereby greatly aiding in the detection of MSNs. Pattern analysis remains the most popular and reliable approach for interpreting dermoscopic findings in MMs diagnosis. Other algorithms applied in the dermoscopic recognition of MMs include the ABCD criteria, Menzies checklist, the three-point check list, the seven-point check list, and the CASH algorithm (11, 19, 25, 26). In reports by Reiter et al. and Warszawik-Hendzel et al., the dermoscopic features of NMMSNs, including the “chaos and clues” method, have been described (12, 27, 28).
For the diagnosis of MSNs, including MMs and NMMSNs (such as BCCs and SCCs), dermoscopy combined with clinical evaluation is more accurate than clinical evaluation alone. The effectiveness of dermoscopy is widely well established and worldwide reports, including meta-analyses, have demonstrated that its use increases diagnostic accuracy of MSNs by 5% to 30% (11, 12, 15-17, 24, 26-28). However, there are some limitations to dermoscopy. It should not be used as a stand-alone diagnostic method without clinical evaluation, since some MSNs cases do not present characteristic dermoscopic features, making their diagnosis less reliable if based solely on dermoscopic morphology. Furthermore, depending on age, skin type or location, the dermoscopic features and patterns of MSNs may vary (29, 30). There also studies in which clinical evaluation alone is assessed as a valuable diagnostic method for MSNs (18, 31-33).
To examine how significantly dermoscopy improves MSNs recognition, in this study, we compared clinical evaluation to clinical evaluation with dermoscopy. These diagnostic methods were applied to all malignant skin neoplasms (MSNs), including separate analyses for MMs and NMMSNs.
Patients and Methods
Patient characteristics. At the PZU Zdrowie Medical Center, Krakow, Poland, 161 skin lesions in 142 patients were excised between December 2021 and August 2025. Surgical procedures were performed for skin lesions with suspected malignancy, i.e., MMs of the skin and NMMSNs, including BCCs and SCCs cases. However, this study also included skin lesions removed for other indications, such as a history of irritation, crusting, recurrent bleeding, or at the patient’s request for cosmetic reasons. A database of excised skin lesions (ESLs) was collected. According to histopathological verification, they were divided into four groups: Group 1: benign skin lesions (BSLs); Group 2: MMs of the skin; Group 3: NMMSNs; and Group 4: all malignant skin neoplasms (MSNs, i.e., all cases from Groups 2 and 3).
Patient diagnosis. Clinical evaluation alone of ESLs (51 cases) was conducted by the surgeon who performed the excision, who had extensive experience in dermatosurgery, with photographic documentation of clinical features recorded before surgery. Clinical evaluation of all ESLs was performed according to the ABCDE-EFG criteria, the Glasgow 7-point checklist in MMs detection, as well as established clinical features of NMMSNs (18-24).
Most ESLs (110 out of 161 cases) underwent clinical evaluation with dermoscopic assessment, which was performed by well-experienced dermatologists in this diagnostic procedure. The preferred dermoscopic equipment were Heine Delta 30, Heine Delta 30 Pro manufactured by HEINE Optotechnik GmbH & Co. KG (Gliching, Germany), and Dermlite DL5 manufactured by DermLite LLC (Aliso Viejo, CA, USA). Pattern analysis (MMs diagnosis) and the “chaos and clues” method (NMMSNs diagnosis) were mainly used in dermoscopic evaluation (11, 12, 19, 25-28). In this ESLs group, including both diagnostic methods for 110 cases, in cases with differences in diagnosis between clinical and dermatoscopic assessment, the dermatoscopic assessment was decisive. Furthermore, videodermoscopy was not used in the dermoscopic examinations.
To ensure greater consistency of the results, in all ESL studies (161 cases), only in-person clinical and dermoscopic assessments were included; evaluations based on image interpretation (image-based assessment) were excluded.
Statistical methods. To assess the effectiveness of the clinical evaluation versus clinical evaluation with dermoscopy, in all cases of ESLs, recognition before surgery was verified with histopathological analysis. We separated the diagnoses into four categories: true positive (TP), false positive (FP), true negative (TN), and false negative (FN). TP referred to ESLs assessed as suspected of MMs (Group 2), NMMSNs (Group 3), or MSNs (Group 4) by clinical evaluation or clinical evaluation with dermoscopy, and confirmed as MMs, NMMSNs, or MSNs on histopathological examination. FP referred to ESLs assessed as neoplastic suspicious, i.e., MMs (Group 2), NMMSNs (Group 3), or MSNs (Group 4), by clinical evaluation with or without dermoscopy, but the diagnosis was not confirmed on histopathology. TN referred to ESLs diagnosed as non-neoplastic, i.e., benign skin lesions (BSLs; Group 1), by clinical evaluation or dermoscopic examination with histological confirmation. FN referred to ESLs considered BSLs (Group 1) before surgery but recognized as neoplastic on histopathological examination.
Based on histopathological verification as the reference standard of diagnostic methods–clinical evaluation and clinical evaluation with dermoscopy–we calculated the sensitivity [TP/(TP+FN)], and the specificity [TN/(TN+FP)]. Two-sided 95% confidence intervals for the sensitivity and specificity were calculated using the Wilson method. The diagnostic odds ratio (DOR) was calculated as DOR=(TP×TN)/(FP×FN). The relative diagnostic odds ratio was defined as RDOR=DOR (test method: clinical evaluation with dermoscopy)/DOR (reference method: clinical evaluation). The two-sided 95% confidence interval (CI) for the DOR and the RDOR was determined using the logarithmic method. The significance of the difference for RDOR between the diagnostic methods was assessed using the Wald test. A p-value of ≤0.05 was considered statistically significant. Microsoft Excel version 2508 (Microsoft Corporation, Redmond, WA, USA) and the R statistical package version 4.03 (R Foundation for Statistical Computing, 1020 Vienna, Austria) were used for statistical analysis.
Results
Database characteristics. In this study, we examined 161 ESLs from 142 patients. These included the following: 128 BSLs, 18 MMs of the skin, and 15 NMMSNs. The lowest median age was 41 years (range=19-76 years) in Group 1 (BSLs), and the highest median age was 62 years (range=46-78 years) in Group 3 (NMMSNs). BSLs were more frequently found in females (56.2%). Females were also more commonly distributed in the neoplastic groups: Group 2, 61.1%; Group 3, 53.3%, and Group 4, 57.6%.
Table I presents the distribution of histopathological diagnoses in 128 cases of BSLs (Group 1). The most frequent were as follows: compound nevus, 52 (40.6%); marginal nevus, 20 (15.6%); intradermal nevus, 15 (11.7%); seborrheic keratosis, 10 (7.8%); and dermatofibroma, 9 (7.0%). In Group 2 (18 MMs cases), there were nine cases of superficial spreading melanoma, seven cases of nodular melanoma, one case of lentigo malignant melanoma, and one case of acral lentiginous melanoma. In Group 3 (15 NMMSNs cases), there were 12 cases of BCCs, and three cases of SCCs.
Patient groups - characteristics.
The lowest median diameter of ESLs was 5.5 mm (range=1-12 mm) in cases of BSLs (Group 1), and the highest median diameter was 8 mm (range=3-12 mm) in NMMSNs (Group 3). The most common locations were the back, 24 cases (18.9%), in BSLs (Group 1); and, in the cancerous groups, the back, five cases (27.8%), in Group 2; the face, eight cases (53.3%), in Group 3; and the face, 10 cases (30.3%), in Group 4 (Table I).
ESLs were assessed by clinical evaluation alone in 51 cases (31.7%), and by clinical evaluation with dermoscopy in 110 cases (68.3%). Clinical evaluation alone was performed in 40 BSLs cases (Group 1), and 11 cancerous cases (five MMs cases - Group 2, and six NMMSNs cases - Group 3). In 110 cases of clinical evaluation with dermoscopy, BSLs were also the most commonly diagnosed (88 cases). In cancerous groups, dermoscopy was used in 22 cases (13 MMs cases and nine NMMSNs cases) (Table I).
Clinical evaluation alone versus clinical evaluation with dermoscopy in the detection of all malignant skin neoplasms. Nine of the eleven histopathologically confirmed MSNs were correctly diagnosed using clinical evaluation (TP), and two cases were incorrectly detected as BSLs (FN). Of the 40 histopathologically verified BSLs cases assessed by clinical evaluation, 30 were correctly identified as benign (TN), while 10 were incorrectly diagnosed as neoplastic suspicious (FP). The sensitivity and the specificity of clinical evaluation for MSNs recognition were 81.8% (95%CI=52.3-94.9] and 75% (95% CI=59.8-85.8), respectively. The DOR for clinical evaluation in MSNs detection was estimated at 13.5 (95% CI=2.5-73.2).
Clinical evaluation with dermoscopy correctly recognized 20 of 22 MSNs cases (TP), with two cases incorrectly detected as BSLs (FN). In 88 cases of BSLs assessed with dermoscopy, 75 cases were correctly diagnosed (TN), and 13 cases were incorrectly diagnosed (FP). Adding dermoscopy to clinical evaluation increased the sensitivity to 90.9% (95% CI=72.2-97.5), specificity to 85.2% (95% CI=76.3-91.2), and DOR to 57.7 (95% CI=12-276.8). The RDOR was 4.27 (95% CI=0.43-42.9, p=0.217) when dermoscopy was added to the clinical evaluation (Table II).
Diagnostic methods in all malignant skin neoplasms detection.
Clinical evaluation alone versus clinical evaluation with dermoscopy in malignant melanomas of the skin detection Four of the five histopathologically verified MMs were correctly diagnosed using clinical evaluation (TP), while a single case was incorrectly recognized as a BSL (FN). The sensitivity, the specificity, and DOR of MMs detection for clinical evaluation were 80% (95% CI=37.6-96.4), 75% (95% CI=59.8-85.8), and 12 (95% CI=1.2-120.3), respectively.
Regarding clinical evaluation plus dermoscopy, 12 of 13 MMs cases were correctly recognized (TP). Adding dermoscopy to clinical evaluation increased the sensitivity to 92.3% (95% CI=66.7-98.6), specificity to 85.2% (95% CI=76.3-91.2), and DOR to 69.2 (95% CI=8.3-578.7). The RDOR was 5.77 (95% CI=0.25-132.51, p=0.273) (Table III).
Diagnostic methods in malignant melanomas of the skin detection.
Clinical evaluation alone versus clinical evaluation with dermoscopy in non-melanoma malignant skin neoplasms detection. Five of the six histopathologically verified NMMSNs were correctly recognized by clinical evaluation (TP), and a single case was incorrectly diagnosed as BSLs (FN). The sensitivity, specificity, and DOR for clinical evaluation in NMMSNs detection were as follows: 83.3% (95% CI=43.6-97), 75% (95% CI=59.8-85.8), and 15 (95% CI=1.6-144.2), respectively.
With dermoscopy added, 8 of 9 NMMSNs cases were correctly diagnosed (TP). Compared to clinical evaluation alone, the sensitivity increased to 88.9% (95% CI=56.5-98), the specificity 85.2% (95% CI=76.3-91.2), and the DOR 46.1 (95% CI=5.3-400.5). The RDOR was 3.08 (95% CI=0.13-70.31, p=0.481) (Table IV).
Diagnostic methods in non-melanoma malignant skin neoplasms detection.
Discussion
Diagnostic methods. Early, correct diagnosis is crucial for the prognosis of patients with MSNs, especially for the more dangerous MMs cases. Early recognition determines treatment methods; for early-stage MMs, curative surgical resection alone may be sufficient, without the need for sentinel lymph node biopsy, immunotherapy, radiotherapy, or chemotherapy as additional treatments (14, 24). Currently, new diagnostic methods such as reflectance confocal microscopy and optical coherence tomography have shown higher sensitivity and specificity than dermoscopy. However, their availability is still limited, and apart from dermoscopy, clinical evaluation remains a first-line diagnostic tool for recognizing MSNs, including both MMs and NMMSNs (9-17, 26). Clinical evaluation of MMs is based on the ABCDE criteria: asymmetry (A), irregular borders (B), color variegation (C), diameter greater than 6 mm (D), and evolution in size, shape, or color (E). The ABCDE-EFG method is used for diagnosing nodular melanoma, adding the next clinical features: elevation (E), firm to touch (F), and rapid growth within several weeks (G). The Glasgow 7-point checklist (7-PCL) is another scale for recognizing MMs, which includes some other clinical features: inflammation, oozing or crusting, and sensory change including itching (19-21).
In NMMSNs cases, a few clinical variants of BCCs are known, but the most common types are nodular (nBCCs), accounting for 75-80% of cases, and superficial (sBCCs), representing 15-20% of cases. nBCCs are mostly located on the face, especially the nose, cheeks, and forehead. They usually present as elevated, red- or flesh-colored, pearly nodules with surface telangiectasias. Nodules may enlarge and ulcerate, giving the borders a rolled or “rodent ulcer” appearance. In contrast, sBCCs look flat, circumscribed, erythematous plaques with slightly raised margins, and are mainly located on the shoulders, chest, or back. Both types of BCCs may also present with a history of irritation, crusting, and recurrent bleeding (22, 23). The most common clinical manifestation of SCCs in situ is an erythematous scaly patch or slightly elevated plaque. However invasive SCCs are often ulcerated and can be patchy, papulonodular, papillomatous, or exophytic (22, 24).
The most popular algorithms applied in the dermoscopic diagnosis of MMs are pattern analysis, ABCD criteria, Menzies checklist, the three-point check list, the seven-point check list, and the CASH algorithm. The main MM characteristic features visualized with dermoscopy are white regression structures, peppering, blue-white veil, atypical blood vessels, atypical pigment network, irregular dots and globules, irregular streaks, multicomponent pattern, pseudopods, and nodules (19, 25, 26). According to Reiter et al.’s report, the most common dermoscopic features seen in BCCs are arborizing vessels, shiny white structures, and large blue-gray ovoid nests (27). The most common dermoscopic features of SCCs include clustered vascular pattern, glomerular vessels, and foci of hyperkeratosis, which appear as discrete yellow scales (24, 28).
Comparison of clinical evaluation alone versus clinical evaluation with dermoscopy. The Cochrane meta-analysis compared clinical evaluation alone with clinical evaluation combined with dermoscopy in MSNs diagnosis (11, 12). Both diagnostic methods were assessed in in-person evaluations: clinical evaluation alone (13 trials; 6,740 lesions and 459 melanomas) versus clinical evaluation with dermoscopy (26 trials; 23,169 lesions and 1,664 melanomas) for the detection of MMs. Clinical evaluation with dermoscopy had higher sensitivity (92% versus 76%; 95% CI=87-95 versus 66-85; p<0001) and higher specificity (95% versus 75%; 95% CI=90-98 versus 57-87; p<0001), with a significant increase in RDOR of 4.7 (95% CI=3.0-7.5; p<0.001). The DOR for in-person evaluations was 13.1 (95% CI=7-24.5) in clinical evaluation alone and 61.7 (95% CI=34.9-109) in clinical evaluation with dermoscopy, respectively (11). This Cochrane review also included 24 prospective trial studies (with 15,660 skin lesions) and found that clinical evaluation with dermoscopy was more accurate than clinical evaluation alone in detecting BCCs. According to in-person evaluations, clinical evaluation with dermoscopy presented higher sensitivity (93% versus 79%) and specificity (99% versus 77%), leading to a significant increase in the RDOR (RDOR=8.2; 95% CI=3.5-19.3) (12).
Other studies reached similar conclusions about the higher accuracy for recognizing MSNs, in cases where dermoscopy was used in addition to the clinical evaluation (15, 17, 27, 28, 34). In a multicenter European trial, 2,522 patients from Southern Europe—Spain and Italy - were randomly assigned to clinical evaluation (1,345 skin lesions in 1,325 patients) or clinical evaluation with dermoscopy (1,203 skin lesions in 1,197 patients). Sensitivity was significantly higher using dermoscopy (79.2% versus 54.1%; p=0.002), while specificity was nearly identical (71.3% and 71.8%) (15). In the meta-analysis by Vestergaard et al., nine clinical trials were analyzed. They found that RDOR for diagnosing MMs using clinical evaluation with dermoscopy compared with clinical evaluation alone was 15.6 (95% CI=2.9-83.7; p=0.016) (17). Kallonati et al. assessed accuracy of both diagnostic methods for diagnosing the atypia features in 118 ESLs (63 common benign nevi, 41 dysplastic nevi, and 14 melanomas). For recognizing atypia features, clinical evaluation alone had 78.2% sensitivity and 71.4% specificity, while dermoscopy presented 89.1% sensitivity and 93.7% specificity (34). In the meta-analysis by Reiter et al., the effectiveness of clinical evaluation with and without dermoscopy was also analyzed regarding the diagnosis of BCCs. The addition of dermoscopy to clinical evaluation improved sensitivity from 67% to 85% (5 trials; 4,455 lesions; p=0.0001) and specificity from 97.2% to 98.2% (3 trials; 3,721 lesions; p=0.006) (27).
There are several factors, which influence the effectiveness of both diagnostic methods for MSNs recognition. Many reports draw attention to the fact that the accuracy of clinical evaluations and dermoscopy depends on the examiner’s experience (11, 12, 15, 35). The Cochrane meta-analysis showed higher accuracy of dermoscopy among more experienced observers compared with less experienced ones (11, 12). For example, in studies with in-person evaluations of MMs, the DOR increased with higher dermoscopic experience as follows: general practitioners, 19.2 (95% CI=1.6-226); residents (mainly dermatology trainees), 51.6 (95% CI=2.9-927); and consultants (mainly dermatologists with specialization), 97.7 (95% CI=35.6-268) (11). In this meta-analysis, relevant differences in diagnosis accuracy for MSNs were also reported between studies conducted in-person and those that evaluated images (11, 12). Accuracy for MMs diagnosis using dermoscopic images and clinical evaluation based on photographs was significantly lower in both diagnostic methods. For image-based evaluations, the DOR in clinical evaluation alone was 3.2 (95% CI=1.9-5.4), compared with 13.1 (95% CI=7-24.5) for in-person evaluations. For clinical evaluation with dermoscopy, the DOR was 17.8 (95% CI=12.3-25.7) in image-based evaluations studies versus 61.7 (95% CI=34.9-109) for in-person evaluations. For MMs, the diagnostic odds ratio of in-person diagnosis was more than four times higher than that of image-based diagnosis (RDOR= 4.6, 95% CI=2.40-9.0; p<0.001) (11).
However, in the Cochrane meta-analysis, the use of algorithms to assist dermoscopy interpretation, i.e., ABCD criteria, Menzies checklist, the three-point check list, the seven-point check list, CASH, the “chaos and clues” method, compared to no reported algorithm or basic algorithm of pattern analysis, had no significant impact on MMs diagnosis. This was true for both in-person evaluations (RDOR=1.4, 95% CI=0.34-5.6; p=0.17) and image-based evaluations (RDOR=1.4, 95% CI=0.60-3.3; p=0.22) (11, 12).
Study limitations. This was a single-center study. The evaluation of diagnostic methods was based on 161 ESLs with 33 cases of malignant skin neoplasms, consisting of 18 MMs and 15 NMMSNs, respectively. Therefore, the number of all cases, including neoplastic cases available for statistical analysis, is relatively small. Additionally, both the diagnostic methods, i.e., clinical evaluation and dermoscopy, were assessed by in-person evaluations; we did not perform image-based evaluations separately. Furthermore, videodermoscopy was not used in dermoscopic evaluation, so the accuracy of this method of diagnosis could be higher. Moreover, other potential diagnostic methods for malignant skin neoplasms recognition, such as reflectance confocal microscopy, electrical impedance spectroscopy, and optical coherence tomography, were not included. Finally, all malignant skin neoplasm groups (Groups 2, 3, and 4) shared the same specificity because they were each compared with the same non-neoplastic group (BSLs; Group 1).
Conclusion
Consistent with the review of world literature, including the largest Cochrane meta-analysis, our study found that clinical evaluation with dermoscopy presented higher sensitivity, specificity, and DOR than clinical evaluation alone in all malignant skin neoplasms detection, with a relative RDOR of 4.27. However, we evaluated both of these diagnostic methods separately for MMs of the skin and NMMSNs. Contrary to the Cochrane meta-analysis, where RDOR was higher in BCCs (RDOR=8.2; 95% CI=3.5-19.3) than MMs cases (RDOR=4.7; 95% CI=3.0-7.5), in this study compared with clinical evaluation alone, dermoscopy appears to be more valuable in detecting MMs than NMMSNs including BCCs (11, 12). For MMs, the advantage of adding dermoscopy was clear: sensitivity increased from 80% to 92.3%, and DOR from 12 to 69.2. In contrast, for NMMSNs, the improvement was less pronounced: sensitivity rose from 83.3% to 88.9%, and DOR from 15 to 46.1. The RDOR was 5.77 (95% CI=0.25-132.51; p=0.273) for MMs and 3.08 (95% CI=0.13-70.31; p=0.481) for NMMSNs.
Footnotes
Authors’ Contributions
Oliwia Majewska: concept of the study, statistical analysis, database results analysis, reviewed articles for the discussion, writing the manuscript. Piotr Kulig: concept of the study, collection and analysis of patient database, statistical analysis, database results analysis, reviewed articles for the discussion. Paweł Brzewski: concept of the study, statistical analysis, database results analysis, reviewed articles for the discussion, critical review. Jan Kulig: concept of the study, critical review. Anna Markiewicz: database results analysis, reviewed articles for the discussion, critical review.
Conflicts of Interest
The Authors declare that they have no conflicts of interest in relation to this study.
Funding
The present study was financially supported by Andrzej Frycz Modrzewski University, Krakow, Poland (Grant no. 30/PRO/1/2026).
Artificial Intelligence (AI) Disclosure
No artificial intelligence (AI) tools, including large language models or machine learning software, were used in the preparation, analysis, or presentation of this manuscript.
- Received January 26, 2026.
- Revision received February 24, 2026.
- Accepted February 27, 2026.
- Copyright © 2026 The Author(s). Published by the International Institute of Anticancer Research.
This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.
References
Jump to section
Related Articles
Cited By...
- No citing articles found.