title: Diagnostic and referral accuracy of family doctors in melanoma screening: effect of a short formal training.
abstract: Little is known about ability of family doctors in the diagnosis and management (decision as to dermatologic referral) of pigmented skin lesions. We sought to evaluate the impact of a short formal training on diagnostic and referral accuracy of family doctors in melanoma screening. A formal 4-h training session was given to a sample of 41 practising family doctors working in the Florence health district, Tuscany, Italy. Before and after the course, a diagnostic test with a series of clinical images of pigmented skin lesions including four invasive melanomas (mean thickness, 1.5 mm; range, 0.8-2.2) was performed (open intervention study). Although only 46.8% of observations yielded a correct melanoma diagnosis at baseline, 96.1% of melanoma observations were correctly associated with intention to refer the lesion to dermatologist. After training, the percentage of correct melanoma diagnosis significantly increased (76.2%, P=0.01) while no further improvement was found as to sensitivity of referral (94.8%, P=0.58). Compared to baseline, post-training evaluation showed a significant reduction of benign lesions sent to dermatologist: the percentage lowered from 52.1 to 35.8% (P=0.0014) for melanocytic nevi and from 38.6 to 17.5% (P<0.001) for benign non-melanocytic lesions (pigmented seborrheic keratoses, dermatofibromas, and vascular lesions). Grouping these two diagnostic categories, the overall specificity in dermatology referral increased from 55.0% at baseline to 73.1% after training (P<0.001). In conclusion, attendance at a 4-h formal training session was able to increase the specificity of family doctors as to dermatologist referral of suspicious lesions (less false-positive referral of benign lesions) without significant loss in sensitivity concerning melanoma.
authors.affiliation: Department of Dermatology, University of Florence, Via degli Alfani 31, 50121 Florence, Italy. CARLI@unifi.it
authors.forename: P
authors.initials: P
authors.lastname: Carli
authors.forename: V
authors.initials: V
authors.lastname: De Giorgi
authors.forename: E
authors.initials: E
authors.lastname: Crocetti
authors.forename: L
authors.initials: L
authors.lastname: Caldini
authors.forename: C
authors.initials: C
authors.lastname: Ressel
authors.forename: B
authors.initials: B
authors.lastname: Giannotti
mesh_terms: D003880:Dermatology; D003937:Diagnosis, Differential; D004502:Education, Medical, Continuing; D005189:False Positive Reactions; D005194:Family Practice; D006801:Humans; D008403:Mass Screening / Q000592:standards*; D008545:Melanoma / Q000175:diagnosis*; D012017:Referral and Consultation; D015203:Reproducibility of Results; D012871:Skin Diseases / Q000175:diagnosis*; D012878:Skin Neoplasms / Q000175:diagnosis*