Diagnosis of malignant melanoma by general practitioners and hospital specialists

Abstract

The aim of this study was to audit all malignant melanomas confirmed histologically in the Scarborough Health District over six years, prompted by the continuing rise in incidence rate nationally and relatively high number of malignant melanomas excised by general practitioners (GPs) in this area. A total of 157 malignant melanomas were diagnosed (60% from females and 40% from males) over the six years; primary excisions being carried out by GPs (37%) and hospital specialists (63%). The clinical diagnosis of malignant melanoma was made in 9% of GP cases and 35% of the hospital specialist cases. However another 45.5% of GP cases, and 38% of hospital specialist cases were regarded as suspicious pigmented lesions clinically. The histological diagnosis was of superficial spreading malignant melanoma in 72% of the GP and 69% of the hospital specialist cases. Most of the GP melanomas were excised with a lateral margin of 2 mm or less (71%); around half of the hospital excisions had a margin of over 2 mm (49%). Most melanomas were 2 mm or less in depth (Breslow depth) in both the GP (81%) and hospital specialist (75%) series. Over the six year period (1993-98) the incidence of malignant melanomas has continued to rise, but Breslow depth at diagnosis has not changed significantly. It is therefore important to continue with early recognition of this condition by GPs in the first instance, reduction in its incidence being the long term goal. During five years of the study there were only 67 lesions thought clinically to be malignant melanoma (26 GP and 41 hospital specialist cases), but which proved to be benign histologically. (Postgrad Med J 2000;76:295-298)

Choosing to biopsy or refer suspicious melanocytic lesions in general practice

“…Furthermore, poor biopsy techniques can mislead, delay, or miss a diagnosis of melanoma [6]. A few studies have reviewed biopsy margins achieved by GPs [7-9], but none have examined how GPs choose to refer or biopsy when presented with suspicious melanocytic lesions.…”

Dermatologists, General Practitioners, and the Best Method to Biopsy Suspect Melanocytic Neoplasms

“…25,26 According to a 2005 analysis of the Australian Medicare reports, Askew et al 25 reported that GPs excised 35.8% and 54.4% of all melanoma and nonmelanoma skin cancers, respectively. Indeed, GPs play a substantial role in our fight against skin cancer because they are the first physicians most patients see and thus may function as the "gatekeepers" to more specialized care.…”

“…In fact, studies have shown that GPs see rarer and, therefore, potentially more difficult-to-diagnose melanoma subtypes such as nodular and amelanotic melanoma. [26][27][28] For example, in the Scarborough Health District in England from 1992 to 1998, GPs saw a higher proportion (24%) of nodular melanoma than did hospital specialists (13%) which included dermatologists and surgeons. 26 Similarly, GPs diagnosed significantly more nodular melanoma (17.7%) than did dermatologists (12.5%) in a Scottish study.…”

“…[26][27][28] For example, in the Scarborough Health District in England from 1992 to 1998, GPs saw a higher proportion (24%) of nodular melanoma than did hospital specialists (13%) which included dermatologists and surgeons. 26 Similarly, GPs diagnosed significantly more nodular melanoma (17.7%) than did dermatologists (12.5%) in a Scottish study. 27 In another report, GPs excised a larger proportion of amelanotic melanoma (7%) than did specialists (2%).…”

Using the 7-point checklist as a diagnostic aid for pigmented skin lesions in general practice: a diagnostic validation study

“…19 Another evaluation, using all the histologically proven cutaneous melanomas diagnosed in Leicestershire between 1982 and 1996, showed a diagnostic sensitivity of 81.5% for the Weighted 7PCL, 20 and a number of similar studies using a referred rather than a primary care population have been reported. 21 An evaluation of the diagnostic performance of the 7PCL in a primary care population has not been identified. This work demonstrates for the first time the performance of the checklist and suggests that specificity of referral may be improved further without loss of sensitivity of melanoma diagnosis by altering the cutoff score.…”