title: Evaluation of aid to diagnosis of pigmented skin lesions in general practice: controlled trial randomised by practice.
abstract: OBJECTIVE
  To determine whether an aid to the diagnosis of pigmented skin lesions reduces the ratio of benign lesions to melanomas excised in general practice.
  
  
  METHODS
  Controlled trial randomised by practice.
  
  
  METHODS
  General practices in Perth, Western Australia.
  
  
  METHODS
  468 general practitioners in 223 practices.
  
  
  METHODS
  Intervention practices were given an algorithm and instant camera to assist with the diagnosis of pigmented skin lesions. All practices were given national guidelines on managing melanoma.
  
  
  METHODS
  Ratio of benign pigmented lesions to melanomas excised. Analyses conducted with and without inclusion of seborrhoeic keratoses.
  
  
  RESULTS
  At baseline the ratios of benign to malignant lesions were lower in the intervention group than in the control group. During the trial period the ratios were higher in the intervention group (19:1 v 17:1 without seborrhoeic keratoses and 29:1 v 26:1 with seborrhoeic keratoses). After adjustment for patients' age, sex, and socioeconomic status, the ratio was 1.02 times higher (95% confidence interval 0.68 to 1.51, P = 0.94) in the intervention group when seborrhoeic keratoses were not included and 1.03 times higher (0.71 to 1.50, P = 0.88) when seborrhoeic keratoses were included. General practitioners in the intervention group were less likely than those in the control group to excise the most recent pigmented skin lesion they managed (22% v 48%, P < 0.001) and to refer the patient to a specialist (16% v 27%, P = 0.06).
  
  
  CONCLUSIONS
  Provision of the algorithm and camera did not decrease the ratio of benign pigmented skin lesions to melanomas excised by general practitioners.
authors.affiliation: The Cancer Council Victoria, Carlton, VIC 3053, Australia. dallas.english@cancervic.org.au
authors.forename: Dallas R
authors.initials: DR
authors.lastname: English
authors.forename: Robert C
authors.initials: RC
authors.lastname: Burton
authors.forename: Chris B
authors.initials: CB
authors.lastname: del Mar
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Donovan
authors.forename: Paul D
authors.initials: PD
authors.lastname: Ireland
authors.forename: Geoff
authors.initials: G
authors.lastname: Emery
mesh_terms: D000465:Algorithms; D003661:Decision Support Techniques; D005194:Family Practice; D019983:Guideline Adherence; D006801:Humans; D008545:Melanoma / Q000175:diagnosis* / Q000601:surgery; D013511:Minor Surgical Procedures / Q000706:statistics & numerical data; D016017:Odds Ratio; D010781:Photography; D010859:Pigmentation Disorders / Q000175:diagnosis* / Q000601:surgery; D017410:Practice Guidelines as Topic; D012878:Skin Neoplasms / Q000175:diagnosis* / Q000601:surgery; D014904:Western Australia