Suspected skin malignancy: a comparison of diagnoses of family practitioners and dermatologists in 493 patients

Background In the Irish health system, dermatology patients present to thei r family practitioner for diagnosis and treatment, and are referred to a de rmatologist for a second opinion where diagnosis is in doubt or when there has been therapeutic failure. The level of expertise in dermatology amongst family practitioners varies considerably. Aim To compare the diagnoses of general practitioners and dermatologists over a selected period in patients with a possible diagnosis of skin cancer. Methods Four hundred and ninety-three patients were seen by one of two derm atologists over a 1-year period at a rapid referral clinic for patients sus pected by their family practitioners of having unstable or possibly maligna nt skin lesions; 213 of these patients had a diagnosis made on clinical exa mination by the dermatologist, while 264 had diagnostic or therapeutic biop sies performed; 16 patients defaulted on surgery. Results The diagnoses of the family practitioners agreed with the diagnoses of the dermatologists on patients diagnosed clinically in 54% of cases. Th irty-eight patients had histologically proven skin malignancy. These were d iagnosed accurately by the referring family practitioner in 22% of patients , while the dermatologists made the correct diagnosis prior to biopsy in 87 %. Conclusions In over 50% of cases diagnosed clinically, the dermatologist an d family practitioner agreed. Histologically proven skin cancers were diagn osed accurately in only 22% of cases by family practitioners, compared to 8 7% of cases by dermatologists. Specific areas of diagnostic difficulty for family practitioners include benign pigmented actinic and seborrheic kerato ses, squamous cell carcinoma, and melanoma. Postgraduate education for fami ly practitioners should be directed towards these areas of deficiency. Derm atologists had difficulty distinguishing pigmented actinic keratoses from m elanoma.