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Dermoscopy Improves Accuracy of Primary Care Physicians to Triage Lesions Suggestive of Skin Cancer

Giuseppe Argenziano, Susana Puig, Iris Zalaudek, Francesco Sera, Rosamaria Corona, Mercè Alsina, Filomena Barbato, Cristina Carrera, Gerardo Ferrara, Antonio Guilabert, Daniela Massi, Juan A. Moreno-Romero, Carlos Muñoz-Santos, Gianluca Petrillo, Sonia Segura, H. Peter Soyer, Renato Zanchini, Josep Malvehy

From the Department of Dermatology, Second University of Naples, Naples; Molecular and Nutritional Epidemiology Unit, Centro Studio e Prevenzione Oncologica, Scientific Institute of Tuscany, Florence; Istituto Dermopatico dell'Immacolata, Rome; Pathologic Anatomy Service, Gaetano Rummo General Hospital, Benevento; Department of Human Pathology and Oncology, University of Florence, Florence, Italy; Department of Dermatology, Medical University of Graz, Graz, Austria; and Department of Dermatology, Melanoma Unit, Hospital Clínic, Institut D’Investigacions Biomèdiques August Pi i Sunyer, University of Barcelona, Barcelona, Spain.

Address reprint requests to Giuseppe Argenziano, MD, Department of Dermatology, Second University of Naples, Via S. Pansini, 5-80131 Naples, Italy; e-mail: argenziano{at}tin.it

PURPOSE: 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.

PATIENTS AND 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).

CONCLUSION: The use of dermoscopy improves the ability of PCPs to triage lesions suggestive of skin cancer without increasing the number of unnecessary expert consultations.

Supported in part by La Roche-Posay, Milan, Italy; 3Gen LLC; the Erwin Schrödinger Fellowship Funding program J2374 by the FWF Austrian Science Fund; Grants Nos. 03/0019 and V2003-REDC03/10 from Fondo de Investigaciones Sanitarias, Spain; and Grants No. RO-1 CA 83115 (fund 538226) from the National Cancer Institute, United States.

Ethical approval was not required because this is not a study that "prospectively assigns human subjects to intervention or comparison groups to evaluate the cause-and-effect relationship between a medical intervention and a health outcome." Although the patients were assessed differently by primary care physicians (a group of them using dermoscopy as an additional tool for the clinical screening of skin tumors), the patients' outcome was not affected because all patients were re-evaluated by expert dermatologists who took the responsibility for the final diagnosis and treatment.

All authors declare their independence from those providing funds.

Authors' disclosures of potential conflicts of interest and author contributions are found at the end of this article.

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