Increase in the sensitivity for melanoma diagnosis by primary care physicians using skin surface microscopy

Background Skin surface microscopy (oil epiluminescence microscopy, dermosc opy, dermatoscopy) has been shown to increase the diagnostic accuracy of me lanoma. However, all studies to date have been in an expert setting. Objectives To determine whether primary care physicians (PCP) (general prac titioners) could improve their melanoma diagnosis using surface microscopy after a short education intervention. Methods Seventy-four practising PCP completed a pretest of 50 melanomas and 50 atypical non-melanoma pigmented skin lesions (PSL) containing matched c linical and surface microscopy photographs. PCP were randomized between a s urface microscopy education intervention or control group, followed by an i dentical post-test. Results Following training there was a significant improvement in the post- test vs. pretest in both clinical melanoma diagnosis (62.7% vs. 54.6%; P = 0.007) and surface microscopy melanoma diagnosis (75.9% vs. 57.8%; P = 0.00 0007). No difference was found in the control group between the post-test v s. pretest clinical melanoma diagnosis (53.7% vs. 50.6%; P = 0.21) or the s urface microscopy melanoma diagnosis (54.8% vs. 52.9%; P = 0.56). Following training there was a significant improvement in the diagnosis of melanoma using surface microscopy vs. clinical diagnosis (75.9% vs. 62.7%; P = 0.000 007), which was absent in the control group (54.8% vs. 53.7%; P = 0.59). No significant difference was found in clinical vs. surface microscopy post-t est results for non-melanoma PSL in either the intervention group or contro l group. Improvement in the sensitivity for the diagnosis of melanoma with surface microscopy was seen without a decrease in specificity; this indicat ed that the effect should occur without increasing the number of needless e xcisions. Conclusions All PCP in countries where melanoma leads to significant mortal ity should be trained in skin surface microscopy.