[How accurate is the clinical diagnosis in skin tumors removed by the family physician, surgeon or dermatologist?].

OBJECTIVE: Checking the agreement of clinical and histopathological diagnoses of skin tumours sent in by general practitioners, surgeons and dermatologists in connection with the desirability of general practitioners removing skin tumours.
DESIGN: Retrospective descriptive study.
SETTING: Diagnostic Centre SSDZ, Delft. MATERIAL AND
METHOD: The clinical diagnoses on application forms and the histopathological diagnosis of skin tumours sent in during the first half of 1993 were compared. A discrepancy was scored if these diagnoses differed considerably. The discrepancies between the diagnoses were classified according to the clinical and histopathological diagnoses: malignant, premalignant or benign conditions.
RESULTS: Discrepancies were present in 31% (specimens from general practitioners), 32% (surgical specimens) and 17% (specimens from dermatologists). The longer differential diagnoses list of the dermatologists flattered this difference. In 9 out of 381 discrepancies a malignant tumour was underrated, in 37 a benign tumor had clinically been regarded as malignant. Dermatologists contributed more malignant and premalignant tumours than the other two groups, more often operated radically (punch biopsies excluded), and made fewer mistakes when they regarded a lesion as benign, but regarded more lesions incorrectly as malignant. Selection of specimens sent in for histopathology may have played a role in this connection.
CONCLUSION: General practitioners and surgeons had about the same number of discrepancies between clinical and histopathological diagnoses. The benefit of histopathological examination of skin tumours was clearly demonstrated.