General practitioner screening for melanoma: sensitivity, specificity, and effect of training

Area of Science:

• Dermatology
• Oncology
• Public Health

Background:

• Melanoma is a significant health concern, particularly in older populations.
• Effective screening strategies are crucial for early detection and improved patient outcomes.

Purpose of the Study:

• To evaluate the performance of trained and untrained general practitioners (GPs) in screening individuals aged 50 and above for melanoma.
• To assess the impact of specific melanoma diagnostic training on GP performance.

Main Methods:

• General practitioners (GPs), both trained and untrained in melanoma diagnosis, alongside skin cancer specialists, examined volunteers.
• Volunteers included individuals with pre-diagnosed suspicious pigmented lesions (SPLs) for histopathological analysis.

Main Results:

• Trained and untrained GPs demonstrated similar sensitivities (0.73 vs. 0.71) and predictive values (0.40 vs. 0.37) for detecting pre-diagnosed SPLs.
• Post-histopathology analysis showed high sensitivities (0.98 vs. 0.95) for both groups in identifying melanoma, but with low specificities (0.52 vs. 0.49) and positive predictive values (0.24 vs. 0.22).
• Trained GPs showed a statistically significant improvement in diagnosing melanomas (p=0.04).

Conclusions:

• GPs achieve high sensitivity in melanoma screening for older adults, though this is accompanied by low specificity and positive predictive values.
• Melanoma diagnostic training did not significantly enhance screening performance in terms of sensitivity, specificity, or positive predictive value.
• Population screening models indicate that GP-led melanoma screening is cost-effective, comparable to cervical cancer screening.