title: [Effectiveness of primary care physicians and dermatologists in the diagnosis of skin cancer: a comparative study in the same geographic area].
abstract: BACKGROUND
  skin cancer is the most common malignant tumor in white individuals. Early diagnosis and treatment are key factors in reducing morbidity. We performed a prospective observational study throughout 2008 to assess the ability of primary care physicians to diagnose nonmelanoma skin cancer.
  
  
  METHODS
  the study was undertaken in a single geographic area corresponding to the region served by a primary health care center. Patients who were referred to a dermatologist were included if the primary care physician indicated skin cancer in the differential diagnosis on the referral form. Patients were also included if the dermatologist suspected skin cancer even if the referral from primary care had not indicated it.
  
  
  RESULTS
  primary care physicians had a sensitivity of 0.45 and a specificity of 0.16 for the diagnosis of skin cancer, whereas dermatologists had a sensitivity of 0.97 and a specificity of 0.75. The α statistic as a measure of agreement was -0.56.
  
  
  CONCLUSIONS
  The ability of primary care physicians to diagnose skin cancer was appreciably lower than that of dermatologists. This may result in substantial delays in the provision of appropriate care for patients with skin cancer considering the role played by primary care physicians in screening for the disease in the Spanish national health system.
authors.affiliation: Servicio de Dermatología, Hospital Comarcal de Sant Boi de Llobregat, Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, Barcelona, España. rosam.ojeda@gmail.com
authors.forename: R M
authors.initials: RM
authors.lastname: Ojeda
authors.forename: J
authors.initials: J
authors.lastname: Graells
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002280:Basal Cell Carcinoma / Q000175:diagnosis; D002294:Carcinoma, Squamous Cell / Q000175:diagnosis; D002391:Catchment Area, Health; D002983:Clinical Competence; D057210:Delayed Diagnosis; D003880:Dermatology; D005260:Female; D006801:Humans; D007636:Keratoacanthoma / Q000175:diagnosis; D008297:Male; D008875:Middle Aged; D058007:Physicians, Primary Care; D011446:Prospective Studies; D012680:Sensitivity and Specificity; D012878:Skin Neoplasms / Q000175:diagnosis*; D013030:Spain