Suspicious skin lesions and their management

Area of Science:

• Dermatology
• General Practice
• Oncology

Background:

• Suspicious skin lesions are a common presentation in general practice.
• Accurate diagnosis and management are crucial for patient outcomes and preventing skin cancer progression.

Purpose of the Study:

• To characterize the range of non-pigmented suspicious skin lesions seen in general practice.
• To evaluate the diagnostic accuracy and management strategies employed by general practitioners for these lesions.

Main Methods:

• General practitioners (GPs) in Queensland, Australia, prospectively recorded data on suspicious skin lesions over six weeks.
• Data included lesion type, clinical diagnosis, and management decisions (biopsy, excision, treatment without biopsy, referral, monitoring).
• Diagnostic accuracy for malignant lesions was calculated, and management options were compared based on diagnostic certainty.

Main Results:

• 1355 lesions were recorded, including non-melanoma skin cancers (28.6%), dysplastic lesions (61.7%), and benign lesions (9.7%).
• Clinical diagnosis of malignancy was correct in 69.1% of histologically confirmed basal cell carcinoma (BCC) or squamous cell carcinoma (SCC) cases.
• Management varied, with excision or biopsy being common for suspected BCC/SCC, while solar keratoses were often treated without biopsy if the diagnosis was certain.

Conclusions:

• General practitioners manage a diverse array of suspicious skin lesions, many of which are benign.
• A significant proportion of concerning lesions are managed conservatively without biopsy.
• Excision or biopsy is the preferred management for suspected basal cell carcinoma or squamous cell carcinoma, or when the diagnosis is uncertain.