Evaluation of aid to diagnosis of pigmented skin lesions in general practice: controlled trial randomised by practice

doi:10.1136/bmj.327.7411.375

BMJ 2003;327:375 (16 August), doi:10.1136/bmj.327.7411.375

Primary care

Evaluation of aid to diagnosis of pigmented skin lesions in general practice: controlled trial randomised by practice

Dallas R English, associate professor¹, Robert C Burton, Professor², Chris B del Mar, professor of general practice³, Robert J Donovan, professor⁴, Paul D Ireland, deputy director², Geoff Emery, general practitioner⁵

¹ The Cancer Council Victoria, Carlton, VIC 3053, Australia, ² National Cancer Control Initiative, Carlton, VIC 3053, Australia, ³ Medical School, University of Queensland, Herston, QLD 4006, Australia, ⁴ Centre for Behavioural Research in Cancer Control, Curtin University of Technology, Bentley, WA 6102, Australia, ⁵ Perth Central Coastal Division of General Practice, Hollywood Private Hospital, Nedlands, WA 6009, Australia

Correspondence to: D English dallas.english{at}cancervic.org.au

Objectives To determine whether an aid to the diagnosis of pigmented skin lesions reduces the ratio of benign lesions to melanomasexcised in general practice.

Design Controlled trial randomised by practice.

Setting General practices in Perth, Western Australia.

Participants 468 general practitioners in 223 practices.

Interventions Intervention practices were given an algorithmand instant camera to assist with the diagnosis of pigmentedskin lesions. All practices were given national guidelineson managing melanoma.

Main outcome measures Ratio of benign pigmented lesions to melanomas excised. Analyses conducted with and without inclusion of seborrhoeic keratoses.

Results At baseline the ratios of benign to malignant lesionswere lower in the intervention group than in the control group.During the trial period the ratios were higher in the interventiongroup (19:1 v 17:1 without seborrhoeic keratoses and 29:1 v26:1 with seborrhoeic keratoses). After adjustment for patients'age, sex, and socioeconomic status, the ratio was 1.02 timeshigher (95% confidence interval 0.68 to 1.51, P = 0.94) inthe intervention group when seborrhoeic keratoses were not included and 1.03 times higher (0.71 to 1.50, P = 0.88) when seborrhoeickeratoses were included. General practitioners in the interventiongroup were less likely than those in the control group to excisethe most recent pigmented skin lesion they managed (22% v 48%,P < 0.001) and to refer the patient to a specialist (16%v 27%, P = 0.06).

Conclusions Provision of the algorithm and camera did not decrease the ratio of benign pigmented skin lesions to melanomas excisedby general practitioners.

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