Dermoscopy improves accuracy of primary care physicians to triage lesions suggestive of skin cancer.
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.
Argenziano
Giuseppe
G
Department of Dermatology, Second University of Naples, Naples, Italy. argenziano@tin.it
Puig
Susana
S
Zalaudek
Iris
I
Sera
Francesco
F
Corona
Rosamaria
R
Alsina
Mercè
M
Barbato
Filomena
F
Carrera
Cristina
C
Ferrara
Gerardo
G
Guilabert
Antonio
A
Massi
Daniela
D
Moreno-Romero
Juan A
JA
Muñoz-Santos
Carlos
C
Petrillo
Gianluca
G
Segura
Sonia
S
Soyer
H Peter
HP
Zanchini
Renato
R
Malvehy
Josep
J
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