A Comparison of Dermatologists' and Primary Care Physicians' Accuracy in Diagnosing Melanoma

Abstract

To compare the accuracy of dermatologists and primary care physicians (PCPs) in identifying pigmented lesions suggestive of melanoma and making the appropriate management decision to perform a biopsy or to refer the patient to a specialist.Data Sources: Studies published between January 1966 and October 1999 in the MEDLINE, EMBASE, and Can-cerLit databases; reference lists of identified studies; abstracts from recent conference proceedings; and direct contact with investigators. Medical subject headings included melanoma, diagnosis, screening, primary care, family practitioner, general practitioner, internal medicine, dermatologist, and skin specialist. Articles were restricted to those involving human subjects.Study Selection: Studies that presented sufficient data to determine the sensitivity and specificity of dermatologists' or PCPs' ability to correctly diagnose lesions suggestive of melanoma and to perform biopsies on or refer patients with such lesions.Data Extraction: Two reviewers independently ab-stracted data regarding the sensitivity and specificity of the dermatologists and PCPs for diagnostic and biopsy or referral accuracy. Disagreements were resolved by discussion. The quality of the studies was also evaluated.Data Synthesis: Thirty-two studies met inclusion criteria; 10 were prospective studies. For diagnostic accuracy, sensitivity was 0.81 to 1.00 for dermatologists and 0.42 to 1.00 for PCPs. None of the studies reported specificity for dermatologists; one reported specificity for PCPs (0.98). For biopsy or referral accuracy, sensitivity ranged from 0.82 to 1.00 for dermatologists and 0.70 to 0.88 for PCPs; specificity, 0.70 to 0.89 for dermatologists and 0.70 to 0.87 for PCPs. Receiver operating characteristic curves for biopsy or referral ability were inconclusive. Conclusions:The published data are inadequate to demonstrate differences in dermatologists' and PCPs' diagnostic and biopsy or referral accuracy of lesions suggestive of melanoma. We offer study design suggestions for future studies.

To excise or not to excise? Should GPs remove possible melanomas?

“…Although a systematic review has suggested that there is insufficient evidence to demonstrate differences in dermatologists' and primary care physicians' diagnostic accuracy of lesions suggestive of melanoma, 10 the current study suggests that melanomas excised in primary care were less likely to have been correctly diagnosed by the person performing the biopsy (19.5% versus 54.7%, P<0.001). Interestingly, a previous study from the same group found that basal cell carcinoma is both less likely to have an accurate diagnosis and less likely to be fully excised if this is done in primary care.…”

Skin Cancer Education for Primary Care Physicians: A Systematic Review of Published Evaluated Interventions

“…The USPSTF made this recommendation based on (1) the lack of quality evidence that links screening to improved health outcomes and (2) limited information about the ability of PCPs to perform adequate examinations in the context of usual care 18 . With regard to the latter, it has been suggested that PCPs may not be prepared or sufficiently trained to identify early skin cancer [18][19][20][21] . An effective training program is essential prior to conducting a rigorous screening trial designed to ultimately determine the efficacy of clinician skin examination and its impact on melanoma mortality reduction.…”

Evaluation of the MoleMateTM training program for assessment of suspicious pigmented lesions in primary care

“…GPs are less accurate than dermatologists in the diagnosis of skin cancers, 4,5 and there is conflicting, 6,7 and probably insufficient, 8 evidence about the confidence and ability of GPs to manage pigmented skin lesions. GPs are able to improve their diagnostic and management skills in dermatology through a variety of training methods, 9 sometimes to the level of specialists.…”