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Multicenter Study
. 2013 May;63(610):e345-53.
doi: 10.3399/bjgp13X667213.

Using the 7-point checklist as a diagnostic aid for pigmented skin lesions in general practice: a diagnostic validation study

Fiona M Walter  1 , A Toby Prevost, Joana Vasconcelos, Per N Hall, Nigel P Burrows, Helen C Morris, Ann Louise Kinmonth, Jon D Emery
Affiliations
Multicenter Study

Using the 7-point checklist as a diagnostic aid for pigmented skin lesions in general practice: a diagnostic validation study

Fiona M Walter et al. Br J Gen Pract. 2013 May.

Abstract

Background: GPs need to recognise significant pigmented skin lesions, given rising UK incidence rates for malignant melanoma. The 7-point checklist (7PCL) has been recommended by NICE (2005) for routine use in UK general practice to identify clinically significant lesions which require urgent referral.

Aim: To validate the Original and Weighted versions of the 7PCL in the primary care setting.

Design and setting: Diagnostic validation study, using data from a SIAscopic diagnostic aid randomised controlled trial in eastern England.

Method: Adults presenting in general practice with a pigmented skin lesion that could not be immediately diagnosed as benign were recruited into the trial. Reference standard diagnoses were histology or dermatology expert opinion; 7PCL scores were calculated blinded to the reference diagnosis. A case was defined as a clinically significant lesion for primary care referral to secondary care (total 1436 lesions: 225 cases, 1211 controls); or melanoma (36).

Results: For diagnosing clinically significant lesions there was a difference between the performance of the Original and Weighted 7PCLs (respectively, area under curve: 0.66, 0.69, difference = 0.03, P<0.001). For the identification of melanoma, similar differences were found. Increasing the Weighted 7PCL's cut-off score from recommended 3 to 4 improved detection of clinically significant lesions in primary care: sensitivity 73.3%, specificity 57.1%, positive predictive value 24.1%, negative predictive value 92.0%, while maintaining high sensitivity of 91.7% and moderate specificity of 53.4% for melanoma.

Conclusion: The Original and Weighted 7PCLs both performed well in a primary care setting to identify clinically significant lesions as well as melanoma. The Weighted 7PCL, with a revised cut-off score of 4 from 3, performs slightly better and could be applied in general practice to support the recognition of clinically significant lesions and therefore the early identification of melanoma.

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Figures

Figure 1
Figure 1
Images of early malignant melanomas to show major features: irregular pigmentation and irregular borders. Left = Early melanoma (0.8mm). Right = Early melanoma (1.0mm)
Figure 1
Figure 1
Images of early malignant melanomas to show major features: irregular pigmentation and irregular borders. Left = Early melanoma (0.8mm). Right = Early melanoma (1.0mm)
Figure 2
Figure 2
ROC curve for the performance of Original and Weighted 7PCL with the clinically significant standard.
Figure 3
Figure 3
ROC curve for the performance of Original and Weighted 7PCL with the melanoma standard.
See this image and copyright information in PMC

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