title: Dermoscopy improves accuracy of primary care physicians to triage lesions suggestive of skin cancer.
abstract: OBJECTIVE
  Primary care physicians (PCPs) constitute an appropriate target for new interventions and educational campaigns designed to increase skin cancer screening and prevention. The aim of this randomized study was to determine whether the adjunct of dermoscopy to the standard clinical examination improves the accuracy of PCPs to triage lesions suggestive of skin cancer.
  
  
  METHODS
  PCPs in Barcelona, Spain, and Naples, Italy, were given a 1-day training course in skin cancer detection and dermoscopic evaluation, and were randomly assigned to the dermoscopy evaluation arm or naked-eye evaluation arm. During a 16-month period, 73 physicians evaluated 2,522 patients with skin lesions who attended their clinics and scored individual lesions as benign or suggestive of skin cancer. All patients were re-evaluated by expert dermatologists at clinics for pigmented lesions. Referral accuracy of both PCP groups was calculated by their scores, which were compared to those tabulated for dermatologists.
  
  
  RESULTS
  Referral sensitivity, specificity, and positive and negative predictive values were 54.1%, 71.3%, 11.3%, and 95.8%, respectively, in the naked-eye arm, and 79.2%, 71.8%, 16.1%, and 98.1%, respectively, in the dermoscopy arm. Significant differences were found in terms of sensitivity and negative predictive value (P = .002 and P = .004, respectively). Histopathologic examination of equivocal lesions revealed 23 malignant skin tumors missed by PCPs performing naked-eye observation and only six by PCPs using dermoscopy (P = .002).
  
  
  CONCLUSIONS
  The use of dermoscopy improves the ability of PCPs to triage lesions suggestive of skin cancer without increasing the number of unnecessary expert consultations.
authors.affiliation: Department of Dermatology, Second University of Naples, Naples, Italy. argenziano@tin.it
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Argenziano
authors.forename: Susana
authors.initials: S
authors.lastname: Puig
authors.forename: Iris
authors.initials: I
authors.lastname: Zalaudek
authors.forename: Francesco
authors.initials: F
authors.lastname: Sera
authors.forename: Rosamaria
authors.initials: R
authors.lastname: Corona
authors.forename: Mercè
authors.initials: M
authors.lastname: Alsina
authors.forename: Filomena
authors.initials: F
authors.lastname: Barbato
authors.forename: Cristina
authors.initials: C
authors.lastname: Carrera
authors.forename: Gerardo
authors.initials: G
authors.lastname: Ferrara
authors.forename: Antonio
authors.initials: A
authors.lastname: Guilabert
authors.forename: Daniela
authors.initials: D
authors.lastname: Massi
authors.forename: Juan A
authors.initials: JA
authors.lastname: Moreno-Romero
authors.forename: Carlos
authors.initials: C
authors.lastname: Muñoz-Santos
authors.forename: Gianluca
authors.initials: G
authors.lastname: Petrillo
authors.forename: Sonia
authors.initials: S
authors.lastname: Segura
authors.forename: H Peter
authors.initials: HP
authors.lastname: Soyer
authors.forename: Renato
authors.initials: R
authors.lastname: Zanchini
authors.forename: Josep
authors.initials: J
authors.lastname: Malvehy
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D046169:Dermoscopy; D003937:Diagnosis, Differential; D004502:Education, Medical, Continuing; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D008875:Middle Aged; D010808:Physical Examination; D011237:Predictive Value of Tests; D011320:Primary Health Care / Q000592:standards*; D012017:Referral and Consultation; D012680:Sensitivity and Specificity; D012878:Skin Neoplasms / Q000175:diagnosis*; D014218:Triage