Study Limitations
The cases used in the study were obtained by SNOMED codes, CDW problem lists, and ICD-9 codes. This method may have missed cases that were assigned incorrect SNOMED codes and were not assigned to the problem list, or that were assigned to the problem list after the study period. The authors used a subset of all reportable cases—namely, those biopsied at VAPSHCS. Although this subset constituted the significant majority of reportable cases, the authors do not know the extent of underreporting of cases that were not biopsied at VAPSHCS. The extent to which other VA facilities generate local SNOMED codes also is unknown.
Conclusion
Melanoma underreporting at VAPSHCS is an addressable concern. The primary cause of underreporting was the use of locally generated SNOMED codes that were not recognized by cancer registry software. The present study should be repeated at other VA facilities to determine the extent to which its findings are generalizable.
Acknowledgments
The authors thank Dr. Stevan Knezevich for reviewing cases, Pam Pehan for providing the list of VAPSHCS melanomas accessioned from VistA, and Eddie Alaniz and Eugene Gavrilenko for helping ascertain SNOMED codes.
Author disclosures
The authors report no actual or potential conflicts of interest with regard to this article.
Disclaimer
The opinions expressed herein are those of the authors and do not necessarily reflect those of Federal Practitioner , Frontline Medical Communications Inc., the U.S. Government, or any of its agencies. This article may discuss unlabeled or investigational use of certain drugs. Please review the complete prescribing information for specific drugs or drug combinations—including indications, contraindications, warnings, and adverse effects—before administering pharmacologic therapy to patients.
