The impact of subspecialization and dermatoscopy use on accuracy of melanoma diagnosis among primary care doctors in Australia - 12/10/12
, Gail Williams, PhD b, Diann Eley, PhD a, Tobias Wilson, Candidate BSc c, Greg Canning, MMed d, Jeffrey Keir, MBBS e, Ian McColl, FACD f, David Wilkinson, DSc a
Correspondence to: Cliff Rosendahl, MBBS, 5 Larbonya Crescent, Capalaba 4157, Australia.Abstract |
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.
Le texte complet de cet article est disponible en PDF.Key words : audit, dermatoscopy, dermoscopy, general practice, melanoma, NNE, NNT, number needed to excise, number needed to treat, subspecialization
Abbreviations used : CI, DSCP, GP, GPSISC, NNT, SCARD
Plan
| Funding sources: None. |
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| Conflicts of interest: None declared. |
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| Reprints not available from the authors. |
Vol 67 - N° 5
P. 846-852 - novembre 2012 Retour au numéro
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