Recognition of skin malignancy by general practitioners: observational study using data from a population-based...

Area of Science:

• Oncology
• Dermatology
• General Practice

Background:

• Skin malignancy incidence is rising in the UK, with most cases initially presenting in primary care.
• Accurate recognition and management of skin lesions in primary care are critical for patient outcomes.
• General practitioners (GPs) manage a significant proportion of minor surgical procedures.

Purpose of the Study:

• To assess the interobserver agreement between general practitioner (GP) diagnosis and histological findings for skin lesions.
• To evaluate the sensitivity of GPs in detecting malignant and pre-malignant skin lesions.
• To inform the discussion on the role and training requirements for GPs in managing potential skin malignancies.

Main Methods:

• Observational study utilizing data from a population-based randomized controlled trial of minor surgery.
• Analysis of 491 skin lesions with traceable histology reports from patients presenting in primary care.
• Calculation of chance-corrected agreement (kappa) and sensitivity for GP diagnosis versus histology.

Main Results:

• A total of 36 lesions (7%) from 33 individuals were found to be malignant or pre-malignant.
• Chance-corrected agreement (kappa) between GP diagnosis and histology was 0.45 for lesions and 0.41 for individuals.
• GP sensitivity for detecting malignant lesions was 66.7% for lesions and 63.6% for individuals.

Conclusions:

• Interobserver agreement for skin malignancy diagnosis by GPs is moderate, indicating potential for missed or incorrect diagnoses.
• Current GP diagnostic accuracy suggests a need for enhanced training to improve the detection and management of skin cancer in primary care.
• While hospital capacity is limited, investing in specialized GP training is essential if primary care is to safely manage the increasing demand for skin lesion diagnosis and treatment.