Diagnosing pigmented skin lesions in general practice: Authors' reply

doi:10.1136/bmj.327.7424.1167-c

BMJ 2003;327:1167-1168 (15 November), doi:10.1136/bmj.327.7424.1167-c

Letter

Diagnosing pigmented skin lesions in general practice

Authors' reply

The first 150 words of the full text of this article appear below.

EDITOR—We hope that views on the effectiveness of a diagnostictechnique are based on the results of well conducted randomisedtrials. We believe that our paper was useful in showing thata method found to be effective in improving specificity withoutdecreasing sensitivity in an earlier and less rigorous trialwas, in fact, not effective.¹

Skin surface microscopy (dermatoscopy, dermoscopy) improvesthe accuracy of diagnosis of pigmented skin lesions when usedby experts but not when used by inexperienced examiners.^2
3Only one randomised trial has been conducted with general practitioners;diagnoses from clinical photographs of 100 pigmented lesionswere compared with those from dermoscopic photographs of thesame lesions. When the general practitioners were trained, theirdiagnoses from the dermoscopic images were more accurate thanthose from the clinical photographs, but without training nodifference in accuracy was observed.⁴

In the absence of trials that mimic actual general . . . [Full text of this article]

D R English, associate professor

Cancer Council Victoria, Carlton, Melbourne, VIC 3053, Australia dallas.english@cancervic.org.au

C B Del Mar, professor of general practice

University of Queensland, Herston, Brisbane, QLD 4006, Australia

R C Burton, professor

National Cancer Control Initiative, Carlton, Melbourne, VIC 3053, Australia