BACKGROUND: Dermatoscopy improves accuracy of melanoma diagnosis, but the impact of subspecialization in skin cancer practice among general practitioners on melanoma diagnostic accuracy is not known. OBJECTIVE: To assess the impact of dermatoscopy use and subspecialization on the accuracy of melanoma diagnosis by general practitioners. METHODS: We did a prospective study on the Skin Cancer Audit Research Database and measured melanoma 'number needed to treat' (NNT), with 21,900 lesions excised to diagnose 2367 melanomas. RESULTS: Melanoma NNT fell from a high of 17.0 (95% confidence interval [CI] 14.5-20.7) among general practitioners with a generalist practice to 9.4 (CI 8.9-10.1) among those with a specific interest in skin cancer, and 8.5 (CI 8.1-9.0) among those practicing only skin cancer medicine (P < .0001). Melanoma NNT fell from a high of 14.6 (CI 12.0-18.6) among dermatoscopy low/non-users to 10.9 (CI 9.8-12.4) among medium users, and 8.9 (CI 8.6-9.3) among high users (P < .0001). The association between NNT and practice type remained (P < .0001) when adjusted for dermatoscopy use and other variables. The association between NNT and dermatoscopy use disappeared (P = .41) when adjusted for practice type and other variables. LIMITATIONS: There is selection bias with respect to participating doctors and completeness and accuracy of data are not independently verified in the Skin Cancer Audit Research Database (SCARD). CONCLUSIONS: General practitioners who subspecialize in skin cancer have a higher use of dermatoscopy and diagnose melanoma with greater accuracy than their generalist counterparts.
BACKGROUND: Dermatoscopy improves accuracy of melanoma diagnosis, but the impact of subspecialization in skin cancer practice among general practitioners on melanoma diagnostic accuracy is not known. OBJECTIVE: To assess the impact of dermatoscopy use and subspecialization on the accuracy of melanoma diagnosis by general practitioners. METHODS: We did a prospective study on the Skin Cancer Audit Research Database and measured melanoma 'number needed to treat' (NNT), with 21,900 lesions excised to diagnose 2367 melanomas. RESULTS:Melanoma NNT fell from a high of 17.0 (95% confidence interval [CI] 14.5-20.7) among general practitioners with a generalist practice to 9.4 (CI 8.9-10.1) among those with a specific interest in skin cancer, and 8.5 (CI 8.1-9.0) among those practicing only skin cancer medicine (P < .0001). Melanoma NNT fell from a high of 14.6 (CI 12.0-18.6) among dermatoscopy low/non-users to 10.9 (CI 9.8-12.4) among medium users, and 8.9 (CI 8.6-9.3) among high users (P < .0001). The association between NNT and practice type remained (P < .0001) when adjusted for dermatoscopy use and other variables. The association between NNT and dermatoscopy use disappeared (P = .41) when adjusted for practice type and other variables. LIMITATIONS: There is selection bias with respect to participating doctors and completeness and accuracy of data are not independently verified in the Skin Cancer Audit Research Database (SCARD). CONCLUSIONS: General practitioners who subspecialize in skin cancer have a higher use of dermatoscopy and diagnose melanoma with greater accuracy than their generalist counterparts.
Authors: Laura K Ferris; Burkhard Jansen; Jonhan Ho; Klaus J Busam; Kenneth Gross; Doyle D Hansen; John P Alsobrook; Zuxu Yao; Gary L Peck; Pedram Gerami Journal: JAMA Dermatol Date: 2017-07-01 Impact factor: 10.282
Authors: Philipp Tschandl; Noel Codella; Bengü Nisa Akay; Giuseppe Argenziano; Ralph P Braun; Horacio Cabo; David Gutman; Allan Halpern; Brian Helba; Rainer Hofmann-Wellenhof; Aimilios Lallas; Jan Lapins; Caterina Longo; Josep Malvehy; Michael A Marchetti; Ashfaq Marghoob; Scott Menzies; Amanda Oakley; John Paoli; Susana Puig; Christoph Rinner; Cliff Rosendahl; Alon Scope; Christoph Sinz; H Peter Soyer; Luc Thomas; Iris Zalaudek; Harald Kittler Journal: Lancet Oncol Date: 2019-06-12 Impact factor: 41.316
Authors: Centaine L Snoswell; Liam J Caffery; Jennifer A Whitty; H Peter Soyer; Louisa G Gordon Journal: JAMA Dermatol Date: 2018-06-01 Impact factor: 10.282
Authors: Kajsa Møllersen; Herbert Kirchesch; Maciel Zortea; Thomas R Schopf; Kristian Hindberg; Fred Godtliebsen Journal: Biomed Res Int Date: 2015-11-26 Impact factor: 3.411