The impact of subspecialization and dermatoscopy use on accuracy of melanoma diagnosis among primary care doctors in Australia

Rosendahl, Cliff, Williams, Gail, Eley, Diann, Wilson, Tobias, Canning, Greg, Keir, Jeffrey, McColl, Ian and Wilkinson, David (2012) The impact of subspecialization and dermatoscopy use on accuracy of melanoma diagnosis among primary care doctors in Australia. Journal of the American Academy of Dermatology, 67 5: 846-852. doi:10.1016/j.jaad.2011.12.030

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Author Rosendahl, Cliff
Williams, Gail
Eley, Diann
Wilson, Tobias
Canning, Greg
Keir, Jeffrey
McColl, Ian
Wilkinson, David
Title The impact of subspecialization and dermatoscopy use on accuracy of melanoma diagnosis among primary care doctors in Australia
Journal name Journal of the American Academy of Dermatology   Check publisher's open access policy
ISSN 0190-9622
1097-6787
Publication date 2012-11
Year available 2012
Sub-type Article (original research)
DOI 10.1016/j.jaad.2011.12.030
Volume 67
Issue 5
Start page 846
End page 852
Total pages 7
Place of publication Philadelphia, PA, United States
Publisher Mosby
Collection year 2013
Language eng
Formatted abstract
Background: Dermatoscopy improves accuracy of melanoma diagnosis, but the impact of subspecialization in skin cancer practice among general practitioners on melanoma diagnostic accuracy is not known.

Objective: To assess the impact of dermatoscopy use and subspecialization on the accuracy of melanoma diagnosis by general practitioners.

Methods: We did a prospective study on the Skin Cancer Audit Research Database and measured melanoma ‘number needed to treat’ (NNT), with 21,900 lesions excised to diagnose 2367 melanomas.

Results: Melanoma NNT fell from a high of 17.0 (95% confidence interval [CI] 14.5-20.7) among general practitioners with a generalist practice to 9.4 (CI 8.9-10.1) among those with a specific interest in skin cancer, and 8.5 (CI 8.1-9.0) among those practicing only skin cancer medicine (P < .0001). Melanoma NNT fell from a high of 14.6 (CI 12.0-18.6) among dermatoscopy low/non-users to 10.9 (CI 9.8-12.4) among medium users, and 8.9 (CI 8.6-9.3) among high users (P < .0001). The association between NNT and practice type remained (P < .0001) when adjusted for dermatoscopy use and other variables. The association between NNT and dermatoscopy use disappeared (P = .41) when adjusted for practice type and other variables.

Limitations: There is selection bias with respect to participating doctors and completeness and accuracy of data are not independently verified in the Skin Cancer Audit Research Database (SCARD).

Conclusions: General practitioners who subspecialize in skin cancer have a higher use of dermatoscopy and diagnose melanoma with greater accuracy than their generalist counterparts.
Keyword Audit
Dermatoscopy
Dermoscopy
General practice
Melanoma
NNE
NNT
Number needed to excise
Number needed to treat
Subspecialization
Sub-specialization
Q-Index Code C1
Q-Index Status Confirmed Code
Institutional Status UQ
Additional Notes Available online 9 February 2012.

Document type: Journal Article
Sub-type: Article (original research)
Collections: Official 2013 Collection
School of Public Health Publications
School of Medicine Publications
 
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Citation counts: TR Web of Science Citation Count  Cited 11 times in Thomson Reuters Web of Science Article | Citations
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Created: Tue, 29 May 2012, 22:24:04 EST by Diann Eley on behalf of School of Medicine