Increase in the sensitivity for melanoma diagnosis by primary care physicians using skin surface microscopy.
BACKGROUND
Skin surface microscopy (oil epiluminescence microscopy, dermoscopy, dermatoscopy) has been shown to increase the diagnostic accuracy of melanoma. However, all studies to date have been in an expert setting.


OBJECTIVE
To determine whether primary care physicians (PCP) (general practitioners) could improve their melanoma diagnosis using surface microscopy after a short education intervention.


METHODS
Seventy-four practising PCP completed a pretest of 50 melanomas and 50 atypical non-melanoma pigmented skin lesions (PSL) containing matched clinical and surface microscopy photographs. PCP were randomized between a surface microscopy education intervention or control group, followed by an identical post-test.


RESULTS
Following training there was a significant improvement in the post-test vs. pretest in both clinical melanoma diagnosis (62.7% vs. 54.6%; P = 0.007) and surface microscopy melanoma diagnosis (75.9% vs. 57.8%; P = 0.000007). No difference was found in the control group between the post-test vs. pretest clinical melanoma diagnosis (53.7% vs. 50.6%; P = 0.21) or the surface microscopy melanoma diagnosis (54.8% vs. 52.9%; P = 0.56). Following training there was a significant improvement in the diagnosis of melanoma using surface microscopy vs. clinical diagnosis (75.9% vs. 62.7%; P = 0.000007), which was absent in the control group (54.8% vs. 53.7%; P = 0.59). No significant difference was found in clinical vs. surface microscopy post-test results for non-melanoma PSL in either the intervention group or control group. Improvement in the sensitivity for the diagnosis of melanoma with surface microscopy was seen without a decrease in specificity; this indicated that the effect should occur without increasing the number of needless excisions.


CONCLUSIONS
All PCP in countries where melanoma leads to significant mortality should be trained in skin surface microscopy.
Westerhoff
K
K
Sydney Melanoma Unit, Melanoma and Skin Cancer Research Institute, Department of Surgery, University of Sydney, Royal Prince Alfred Hospital, Missenden Road, Camperdown, NSW 2050, Australia.
McCarthy
W H
WH
Menzies
S W
SW
D002983:Clinical Competence; D003880:Dermatology / Q000193:education; D004502:Education, Medical, Continuing; D005194:Family Practice / Q000193:education / Q000379:methods*; D006801:Humans; D008545:Melanoma / Q000175:diagnosis*; D008853:Microscopy; D011320:Primary Health Care / Q000379:methods; D012878:Skin Neoplasms / Q000175:diagnosis*