Je. Osborne et al., THE EFFECT OF THE INTRODUCTION OF A PIGMENTED LESION CLINIC ON THE INTERVAL BETWEEN REFERRAL BY FAMILY PRACTITIONER AND ATTENDANCE AT HOSPITAL, British journal of dermatology, 138(3), 1998, pp. 418-421
The value of pigmented lesion clinics (PLCs) for the early detection a
nd treatment of malignant melanoma has been questioned. We have examin
ed the effect of the introduction of a PLC on the referral interval be
tween patients with melanoma presenting to their general practitioner
(GP) and their attendance at hospital. The case notes of all patients
presenting with melanoma in Leicestershire between 1984 and 1994 were
reviewed. There was a significant initial reduction in the mean referr
al interval following the introduction of the PLC from 27.9 days (SEM
= 6.6) in 1984 to 11.3 (2.3) days in 1987 (P<0.01). However, the refer
ral interval gradually rose over the following 7 years to a mean of 20
.4 (4.4) days in 1994, which was not significantly better than the 198
5/86 level. The increase in the referral interval was due to a greater
percentage of melanomas being referred to clinics other than the PLC.
Only 48% of melanomas were referred to the PLC in 1994 compared with
70% in 1987. We also reviewed the referral letters for those patients
presenting in 1991 and 1994, and decided, on the basis of the content
of the letter, whether the GP had suspected the diagnosis of melanoma.
More than 50% of the melanomas were correctly diagnosed by the GP, bu
t only half of these were then appropriately referred to the PLC. We b
elieve that PLCs are of value in the early diagnosis and treatment of
melanoma, but only if they are appropriately utilized by GPs.