The impact of subspecialization and dermatoscopy use on accuracy of melanoma diagnosis among primary care doctors in Australia

Rosendahl, Cliff; Williams, Gail M.; Eley, Diann; Wilson, Tobias; Canning, Greg; Keir, Jeffrey; McColl, Ian; Wilkinson, David

doi:10.1016/j.jaad.2011.12.030

Cited by 51 publications

(82 citation statements)

References 23 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…We found almost universal routine dermoscopy use when reviewing pigmented skin lesions (97%). This is likely to be at least partly due to two‐thirds of our respondents reporting a personal history of dermatology posts and qualifications, in keeping with Australian evidence that GP subspecialisation in dermatology leads to increased rates of dermoscopy use . This very high level of dermoscopy use is closer to that of UK dermatologists in 2012 (99%), than for primary care practitioners internationally (34% in Australia in 2007 and 8% in France in 2016), or in our pilot survey of UK GPs without a special interest in dermatology ( n = 77, 17%) (unpublished data).…”

Section: Discussionsupporting

confidence: 71%

Dermoscopy use in UK primary care: a survey of GPs with a special interest in dermatology

Jones

Jurascheck

Utukuri

et al. 2019

Acad Dermatol Venereol

View full text Add to dashboard Cite

Background Melanoma accounts for 90% of skin cancer mortality and typically presents in primary care, where it can be challenging to distinguish from benign lesions. Dermoscopy is a tool for skin visualization that is routinely used for melanoma diagnosis in secondary care. However, the role of dermoscopy in primary care remains unclear. Objectives To determine views on, and use of, dermoscopy by dermatology‐interested general practitioners (GPs). Methods An online questionnaire was emailed to the UK Primary Care Dermatology Society members in February 2018, and responses collected over the following 4 weeks. Results A total of 205 responses were analysed. Most respondents were GPs (94%), aged over 50 (53%), had a postgraduate dermatological qualification (67%) and used dermoscopy regularly when reviewing pigmented skin lesions (97%). Dermoscopy use was commoner amongst GPs who had worked longer in primary care and had experience of secondary care dermatology. Most had undertaken training in dermoscopy (91%), although one‐fifth (20%) had not updated their training in over 5 years. Most of those who had received only 1 day of face‐to‐face training reported feeling confident using a dermatoscope. Few respondents (11%) reported access to teledermatology or teledermoscopy for urgent or routine referrals. Conclusions UK GPs with a special interest in dermatology are routinely using dermoscopy in the primary care setting. More research is needed to establish optimal approaches to training and updating GP dermoscopy skills. When dermoscopy has been shown to be safe, effective, acceptable and cost‐effective in this setting, more GPs may also be able to gain and maintain the skills to implement dermoscopy into routine primary care. Technological advances, including incorporation of artificial intelligence (AI) and algorithms to guide GPs, could also contribute to widening use of dermoscopy among GPs.

show abstract

Section: Discussionsupporting

confidence: 71%

Dermoscopy use in UK primary care: a survey of GPs with a special interest in dermatology

Jones

Jurascheck

Utukuri

et al. 2019

Acad Dermatol Venereol

View full text Add to dashboard Cite

show abstract

“…In case of a shave procedure of a melanoma, the GP was mostly in the assumption of treating a benign naevus. A dermatoscope may be a useful tool to help the GP differentiate between melanomas and benign lesions, however adequate experience is necessary [16,17]. …”

Section: Discussionmentioning

confidence: 99%

Skin Tumour Surgery in Primary Care: Do General Practitioners Need to Improve Their Surgical Skills?

Rijsingen¹,

Vossen²,

Huystee

et al. 2015

Dermatology

View full text Add to dashboard Cite

Background: Due to a rapid increase in the incidence of skin cancer, it seems inevitable that general practitioners (GPs) will play a larger role in skin cancer care. Objectives: To assess surgical procedures used by GPs in skin tumour management. Methods: We performed a retrospective study of 1,898 pathology reports of skin tumours excised by GPs in 2009. Results: In 22.9% no diagnosis was provided on the application form. Mostly, once-off excisions (no preceding biopsy) were performed, 7% of the excised lesions were malignant, and 35% of incisions were incomplete. Excisions in the face and neck region were incomplete in 65.4%; 22% of melanomas were biopsied or shaved. Conclusion: This study underlines the difficulties in skin tumour management in primary care. To stimulate adequate resource use, the number of excisions of benign lesions could be lowered, and pretreatment biopsy in non-melanoma skin cancer management should be encouraged. GPs should be aware of their limitations and consider referral of high-risk malignancies.

show abstract

“…The percentage of melanomas which were nodular was therefore 2.4% of total melanomas and 10.2% of invasive melanomas. From January 1, 2008, to June 30, 2013, the ‘Number Needed to Treat’ (NNT) with respect to all melanomas diagnosed in this practice, calculated from the prospectively declared intention to confirm or exclude melanoma, was 5.36 [6]. …”

Section: Methodsmentioning

confidence: 99%

Nodular melanoma: five consecutive cases in a general practice with polarized and non-polarized dermatoscopy and dermatopathology

Rosendahl

Hishon

Cameron

et al. 2014

Dermatol Pract Concept

Self Cite

View full text Add to dashboard Cite

Background:The incidence of nodular melanoma (NM) has been consistently described as at least 10–15% of total melanomas for over 15 years despite advances in diagnostic algorithms and medical technology. NMs are strongly correlated with faster rates of growth and poorer prognosis and thus provide clinicians with a challenge for early recognition.Objective:To evaluate diagnostic clues of consecutive histopathologically proven NMs in one general practice with particular emphasis on dermatoscopic characteristics and compare this to the published literature.Method:A retrospective observational study was performed of five consecutive histologically proven NM, from a total of 212 consecutive melanomas from a general practice in Brisbane, Queensland, Australia. Dermatoscopic images, both polarized and non-polarized, which appears to be a unique resource, and dermatopathologic slides were available for all lesions.Results:All of the NMs in this series were pigmented although one was hypomelanotic. Two of them were symmetrical. The most highly sensitive clues to NM were gray or blue structures and polarizing-specific white lines.Limitations:Due to the small number of NMs in this report no statistical significance can be attributed to the observational findings.Conclusion:This small series supports what is already known: that a significant proportion of NMs may be dermatoscopically symmetrical but that known clues to melanoma are frequently present. Nodular lesions, pigmented or non-pigmented, should be excised to exclude NM if there is any clue to malignancy, regardless of symmetry, unless a confident specific benign diagnosis can be made.

show abstract

The impact of subspecialization and dermatoscopy use on accuracy of melanoma diagnosis among primary care doctors in Australia

Cited by 51 publications

References 23 publications

Dermoscopy use in UK primary care: a survey of GPs with a special interest in dermatology

Dermoscopy use in UK primary care: a survey of GPs with a special interest in dermatology

Skin Tumour Surgery in Primary Care: Do General Practitioners Need to Improve Their Surgical Skills?

Nodular melanoma: five consecutive cases in a general practice with polarized and non-polarized dermatoscopy and dermatopathology

Contact Info

Product

Resources

About