BACKGROUND: In the Irish health system, dermatology patients present to their family practitioner for diagnosis and treatment, and are referred to a dermatologist for a second opinion where diagnosis is in doubt or when there has been therapeutic failure. The level of expertise in dermatology amongst family practitioners varies considerably. AIM: To compare the diagnoses of general practitioners and dermatologists over a selected period in patients with a possible diagnosis of skin cancer. METHODS: Four hundred and ninety-three patients were seen by one of two dermatologists over a 1-year period at a rapid referral clinic for patients suspected by their family practitioners of having unstable or possibly malignant skin lesions; 213 of these patients had a diagnosis made on clinical examination by the dermatologist, while 264 had diagnostic or therapeutic biopsies performed; 16 patients defaulted on surgery. RESULTS: The diagnoses of the family practitioners agreed with the diagnoses of the dermatologists on patients diagnosed clinically in 54% of cases. Thirty-eight patients had histologically proven skin malignancy. These were diagnosed accurately by the referring family practitioner in 22% of patients, while the dermatologists made the correct diagnosis prior to biopsy in 87%. CONCLUSIONS: In over 50% of cases diagnosed clinically, the dermatologist and family practitioner agreed. Histologically proven skin cancers were diagnosed accurately in only 22% of cases by family practitioners, compared to 87% of cases by dermatologists. Specific areas of diagnostic difficulty for family practitioners include benign pigmented actinic and seborrheic keratoses, squamous cell carcinoma, and melanoma. Postgraduate education for family practitioners should be directed towards these areas of deficiency. Dermatologists had difficulty distinguishing pigmented actinic keratoses from melanoma.
BACKGROUND: In the Irish health system, dermatology patients present to their family practitioner for diagnosis and treatment, and are referred to a dermatologist for a second opinion where diagnosis is in doubt or when there has been therapeutic failure. The level of expertise in dermatology amongst family practitioners varies considerably. AIM: To compare the diagnoses of general practitioners and dermatologists over a selected period in patients with a possible diagnosis of skin cancer. METHODS: Four hundred and ninety-three patients were seen by one of two dermatologists over a 1-year period at a rapid referral clinic for patients suspected by their family practitioners of having unstable or possibly malignant skin lesions; 213 of these patients had a diagnosis made on clinical examination by the dermatologist, while 264 had diagnostic or therapeutic biopsies performed; 16 patients defaulted on surgery. RESULTS: The diagnoses of the family practitioners agreed with the diagnoses of the dermatologists on patients diagnosed clinically in 54% of cases. Thirty-eight patients had histologically proven skin malignancy. These were diagnosed accurately by the referring family practitioner in 22% of patients, while the dermatologists made the correct diagnosis prior to biopsy in 87%. CONCLUSIONS: In over 50% of cases diagnosed clinically, the dermatologist and family practitioner agreed. Histologically proven skin cancers were diagnosed accurately in only 22% of cases by family practitioners, compared to 87% of cases by dermatologists. Specific areas of diagnostic difficulty for family practitioners include benign pigmented actinic and seborrheic keratoses, squamous cell carcinoma, and melanoma. Postgraduate education for family practitioners should be directed towards these areas of deficiency. Dermatologists had difficulty distinguishing pigmented actinic keratoses from melanoma.
Authors: Fiona M Walter; Helen C Morris; Elka Humphrys; Per N Hall; Ann Louise Kinmonth; A Toby Prevost; Edward Cf Wilson; Nigel Burrows; Paul Norris; Margaret Johnson; Jon Emery Journal: BMC Fam Pract Date: 2010-05-11 Impact factor: 2.497
Authors: Rosa Taberner Ferrer; Antonio Pareja Bezares; Alex Llambrich Mañes; Antonia Vila Mas; Ignacio Torné Gutiérrez; Cristina Nadal Lladó; Guillermo Mas Estaràs Journal: Aten Primaria Date: 2009-06-05 Impact factor: 1.137
Authors: Jacqueline Dinnes; Jonathan J Deeks; Naomi Chuchu; Rubeta N Matin; Kai Yuen Wong; Roger Benjamin Aldridge; Alana Durack; Abha Gulati; Sue Ann Chan; Louise Johnston; Susan E Bayliss; Jo Leonardi-Bee; Yemisi Takwoingi; Clare Davenport; Colette O'Sullivan; Hamid Tehrani; Hywel C Williams Journal: Cochrane Database Syst Rev Date: 2018-12-04
Authors: Jacqueline Dinnes; Jonathan J Deeks; Matthew J Grainge; Naomi Chuchu; Lavinia Ferrante di Ruffano; Rubeta N Matin; David R Thomson; Kai Yuen Wong; Roger Benjamin Aldridge; Rachel Abbott; Monica Fawzy; Susan E Bayliss; Yemisi Takwoingi; Clare Davenport; Kathie Godfrey; Fiona M Walter; Hywel C Williams Journal: Cochrane Database Syst Rev Date: 2018-12-04