Primary Care Clinicians' Performance for Detecting Actinic Keratoses and Skin Cancer

Whited, John D.

doi:10.1001/archinte.1997.00440300089007

Cited by 44 publications

(4 citation statements)

References 26 publications

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“…6,14,18,35,36 Our finding that primary care physicians were less likely to counsel their patients on skin cancer and sunscreen use if those physicians were from an academic or hospital setting is consistent with a recent survey that found pediatricians in health maintenance organizations and private settings more likely to counsel about skin cancer than pediatricians in academic institutions or community health centers. 15 Perhaps office and managed care settings are more likely to have guidelines addressing skin cancer prevention.…”

Section: Arch Dermatol / Vol 136 May 2000supporting

confidence: 85%

Personal and Clinical Skin Cancer Prevention Practices of US Women Physicians

Saraiya

Frank²,

Elon³

et al. 2000

Arch Dermatol

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Section: Arch Dermatol / Vol 136 May 2000supporting

confidence: 85%

Personal and Clinical Skin Cancer Prevention Practices of US Women Physicians

Saraiya

Frank²,

Elon³

et al. 2000

Arch Dermatol

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“…It is reassuring for us, but perhaps not for patients, that our results are echoed in studies from other countries. Whited et al (1997) showed that primary care clinicians identified the presence of skin cancer with a sensitivity of 57% (95% CI, 44 -68%) in one US study and ). In the face of rising skin cancer incidence it is clear that the major challenge of providing minor surgery in primary care is the potential for missed diagnosis of serious skin malignancies (Diffey, 2004).…”

Section: Discussionmentioning

confidence: 97%

Recognition of skin malignancy by general practitioners: observational study using data from a population-based randomised controlled trial

et al. 2009

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Skin malignancy is an important cause of mortality in the United Kingdom and is rising in incidence every year. Most skin cancer presents in primary care, and an important determinant of outcome is initial recognition and management of the lesion. Here we present an observational study of interobserver agreement using data from a population-based randomised controlled trial of minor surgery. Trial participants comprised patients presenting in primary care and needing minor surgery in whom recruiting doctors felt to be able to offer treatment themselves or to be able to refer to a colleague in primary care. They are thus relatively unselected. The skin procedures undertaken in the randomised controlled trial generated 491 lesions with a traceable histology report: 36 lesions (7%) from 33 individuals were malignant or pre-malignant. Chance-corrected agreement (k) between general practitioner (GP) diagnosis of malignancy and histology was 0.45 (0.36 -0.54) for lesions and 0.41 (0.32 -0.51) for individuals affected with malignancy. Sensitivity of GPs for the detection of malignant lesions was 66.7% (95% confidence interval (CI), 50.3 -79.8) for lesions and 63.6% (95% CI, 46.7 -77.8) for individuals affected with malignancy. The safety of patients is of paramount importance and it is unsafe to leave the diagnosis and treatment of potential skin malignancy in the hands of doctors who have limited training and experience. However, the capacity to undertake all of the minor surgical demand works demanded in hospitals does not exist. If the capacity to undertake it is present in primary care, then the increased costs associated with enhanced training for general medical practitioners (GPs) must be borne.

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“…Whited et al 10 examined the ability of primary care physicians to diagnose AKs and NMSC using der- matologists' clinical impressions as the gold standard and found again that for the diagnosis of AKs, the interobserver variability among dermatologists was unreliable.…”

Section: Commentmentioning

confidence: 99%