The effect of the introduction of a pigmented lesion clinic on the interval between referral by family practitioner and attendance at hospital

Abstract

The value of pigmented lesion clinics (PLCs) for the early detection and treatment of malignant melanoma has been questioned. We have examined the effect of the introduction of a PLC on the referral interval between patients with melanoma presenting to their general practitioner (GP) and their attendance at hospital. The case notes of all patients presenting with melanoma in Leicestershire between 1984 and 1994 were reviewed. There was a significant initial reduction in the mean referral interval following the introduction of the PLC from 27.9 days (SEM = 6.6) in 1984 to 11.3 (2.3) days in 1987 (P < 0.01). However, the referral interval gradually rose over the following 7 years to a mean of 20.4 (4.4) days in 1994, which was not significantly better than the 1985/86 level. The increase in the referral interval was due to a greater percentage of melanomas being referred to clinics other than the PLC. Only 48% of melanomas were referred to the PLC in 1994 compared with 70% in 1987. We also reviewed the referral letters for those patients presenting in 1991 and 1994, and decided, on the basis of the content of the letter, whether the GP had suspected the diagnosis of melanoma. More than 50% of the melanomas were correctly diagnosed by the GP, but only half of these were then appropriately referred to the PLC. We believe that PLCs are of value in the early diagnosis and treatment of melanoma, but only if they are appropriately utilized by GPs.

Clinical correlates of Breslow thickness of malignant melanoma

“…A further point is that this theory of deliberate referral of thick lesions to surgeons does not explain why thicker lesions are also referred to ordinary dermatology clinics. More work is necessary to determine the cause of the referral pattern because we have previously shown that referral to clinics other than the PLC is associated with delay between first referral and presentation at hospital 31 …”

Surgical treatment of melanoma

“…Similarly, melanoma screening days may not be a particularly cost‐effective way of seeing and treating melanoma cases more quickly 21 . The use of targeted referrals to PLCs is likely to be more valuable in the early diagnosis and treatment of melanoma, 22 and the false‐negative rate of diagnosis in PLCs has been shown to be small 23,24 . Furthermore, the use of dermoscopy in PLCs, either on its own 25 or using sophisticated image analysis, 26,27 may make PLCs more efficient and reduce both false‐positive and false‐negative results.…”

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

“…16,17 Another study did not report the number of melanomas that were shown to the subjects. 18 We also excluded a study 19 that evaluated referrals to a pigmented lesion clinic because referral to this clinic would…”