Comparison of Dermatologists' and Nondermatologists' Diagnostic Accuracy for Malignant Melanoma
Abstract
Abstract
Background:
The incidence of malignant melanoma is increasing annually in Canada and patients present to nondermatologist groups (NDGs) first to have suspicious lesions examined.
Objective:
To determine the ability of Canadian NDGs in the recognition and management of melanoma.
Methods:
A survey of 25 malignant and benign skin lesion photographs was distributed to dermatologists and NDGs across Canada. Participants were asked to list whether the lesions were malignant or benign, and could answer ‘uncertain’ if needed. Dermatologists were subsequently asked if they would biopsy the lesion, whereas NDGs were asked if they would biopsy/refer.
Results:
Dermatologists achieved mean sensitivities, specificities, and diagnostic accuracies of 0.79, 0.77, and 0.71, respectively. They consistently decided to biopsy malignant lesions. NDGs attained mean scores of 0.61, 0.62, and 0.53, respectively, and selected to refer/biopsy the majority of lesions, malignant and benign.
Conclusions:
NDGs should receive more dermatologic training in the recognition of malignant melanoma.
Résumé
Contexte:
La fréquence du mélanome malin augmente d'année en année, au Canada, et les patients consultent d'abord des non-dermatologues (ND) pour l'examen des lésions douteuses.
Objectif:
L'étude avait pour objectif de déterminer la capacité des ND, au Canada, à reconnaître et à prendre en charge le mélanome.
Méthode:
Une enquête comptant 25 photographies de lésions malignes et de lésions bénignes de la peau a été envoyée à des dermatologues et à des ND, partout au Canada. On a demandé aux participants d'indiquer si ces lésions étaient malignes ou bénignes; en cas de doute, ils pouvaient inscrire « incertain ». Par la suite, on a demandé aux dermatologues s'ils pratiqueraient une biopsie des lésions, et aux ND s'ils pratiqueraient une biopsie des lésions ou s'ils dirigeraient les patients vers un spécialiste.
Résultats:
La sensibilité, la spécificité, et la précision du diagnostic parmi les dermatologues s'élevaient en moyenne à 0.79, 0.77, et 0.71, respectivement, et ils ont décidé de pratiquer une biopsie dans tous les cas de lésions malignes. Quant aux ND, ils ont obtenu une moyenne de 0.61, 0.62, et 0.53, respectivement, et ils ont choisi de diriger les patients vers un spécialiste ou de pratiquer une biopsie dans la majorité des lésions, malignes ou bénignes.
Conclusion:
Les ND devraient recevoir plus de formation en dermatologie sur la reconnaissance du mélanome malin.
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Article first published online: July 1, 2012
Issue published: July/August 2012
PubMed: 22784521
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