Can nurses with training in dermatology reliably differentiate skin lesions?: A diagnostic concordance study

To evaluate the diagnostic ability of nurses with training in dermatology in the screening of skin lesions and their level of agreement with dermatologists.

A cross-sectional observational diagnostic concordance study was conducted between October 2024 and April 2025 in the outpatient clinics of the Avenida de Portugal Peripheral Specialty Center of Hospital Clínico San Carlos. A total of 122 patients referred from primary care due to suspected skin lesions were included through consecutive sampling. Lesions were assessed by nurses with training in dermatology and subsequently evaluated by dermatologists, considered the reference standard. Cohen's kappa index, sensitivity, specificity, predictive values, and 95% confidence intervals were calculated.

Agreement between nursing staff and dermatologists was high (kappa = 0.982), whereas agreement between primary care and dermatologists was low (kappa = 0.265). The sensitivity and specificity of trained nurses were both 100% (95% CI: 90.5%-100% and 95.7%-100%, respectively), while those of primary care were 51% and 78.57%, respectively.

Nurses with training in dermatology showed a high level of diagnostic agreement with dermatologists in the screening of skin lesions within this clinical setting. However, the results should be interpreted with caution due to methodological limitations, such as the absence of blinding and the observational design of the study.