Letters Melanomas in primary care

Editorial on identifying melanomas in primary care was muddled

BMJ 2012; 345 doi: https://doi.org/10.1136/bmj.e5416 (Published 21 August 2012) Cite this as: BMJ 2012;345:e5416
  1. Joanna Bayley, general practitioner1
  1. 1Gloucester Health Access Centre, Gloucester GL1 1PX, UK
  1. joannabayley{at}yahoo.com

Newton-Bishop and Lorigan’s thinking on whether we can improve the identification of melanomas in primary care is muddled and their conclusions are lazy.1 They object to current referral rates for suspected melanoma, despite 91% compliance with referral guidelines, but offer no guidance on what referral rates should be. They give no international comparators to indicate whether UK practice is at variance with global norms. Instead, they offer a ridiculous comparison with the rate of positive diagnoses in suspected leukaemia, which is diagnosed with an objective blood test for which no dermatological equivalent exists.

They seem to believe that too many possible skin cancers are referred and quote the UK statistics disparagingly, despite providing no objective evidence of underperformance. Extraordinarily, they use the term “correct” for referrals that lead to a diagnosis of skin cancer. Are they really suggesting that it is “incorrect” to refer a possible cancer unless it is retrospectively confirmed as cancerous? The most charitable interpretation is that their grasp of logic has failed. A less charitable one is that they are promoting the dangerous idea that GPs are somehow failing if they refer possible skin cancers that turn out to be benign.

Having denounced GPs for supposedly over-referring suspected cancers, they conclude that the higher average stage of melanoma at presentation in the UK (compared with Europe) is “probably” due to GPs’ lack of dermatological training. By this stage, the reader can hardly be surprised that the authors offer no evidence for another slur on primary care. The possibility of patients presenting late to GPs is not considered, and neither do the authors stop to wonder how GPs could refer too late while complying closely with expert referral guidelines.


Cite this as: BMJ 2012;345:e5416


  • Competing interests: None declared.


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