AID TO DIAGNOSIS OF MELANOMA IN PRIMARY MEDICAL-CARE

Objective-To evaluate an intervention designed to reduce the number of benign melanocytic lesions excised from the skin. Design-A randomised controlled field trial based in the medical practices of two cities. Examination of histopathological reports of 5823 melanocytic skin lesi ons excised over the intervention period and in the preceding six mont hs Intervention-Medical practitioners were offered an algorithm and us e of an instant developing camera. Setting and subjects-Over 50 medica l practitioners, mostly in general practice, in each of two cities in tropical Queensland, Australia. Main outcome measures-Percentages of b enign (neither malignant nor potentially malignant) melanocytic lesion s excised during the two year intervention period. Results-There were no significant differences in the percentages of benign lesions report ed in the intervention and control cities before the intervention star ted (93.6% and 94.0%, respectively), but there was a significant diffe rence afterwards (88.8% and 93.8%, P<0.001). There was no difference i n the percentage of invasive melanomas excised per month in the interv ention city (3.4%) compared with control city (3.4%). Conclusion-Clini cal diagnostic accuracy may be enhanced by offering to clinicians mana ging suspicious melanocytic skin lesions a simple algorithm and a came ra with which to record the appearance of lesions objectively.