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. 2023 Aug;64(3):378-388.
doi: 10.1111/ajd.14061. Epub 2023 Apr 24.

Practitioner characteristics, diagnostic accuracy metrics and discovering-individual with respect to 637 melanomas documented by 27 general practitioners on the Skin Cancer Audit Research Database

Martelle Coetzer-Botha  1 , Clara Jimenez Balcells  2   3 , Jeremy Hay  4 , Jeff Keir  1 , Nikita Rosendahl  5 , Tobias Wilson  6 , Simon Clark  5   7 , Astrid Baade  8 , Cath Becker  9   10 , Luke Bookallil  11 , Chris Clifopoulos  1 , Tony Dicker  1 , Martin Paul Denby  12 , Douglas Duthie  13 , Charles Elliott  14 , Paul Fishburn  1 , Mark Foley  15 , Mark Franck  16 , Irene Giam  17 , Patricio Gordillo  18 , Alister Lilleyman  19 , Roger Macauley  20 , James Maher  21 , Ewen McPhee  22 , Michael Reid  23 , Bob Shirlaw  24 , Graeme Siggs  25 , Robert Spark  26 , John Stretch  27 , Keith van Den Heever  28 , Thinus van Rensburg  29 , Chris Watson  30 , Harald Kittler  31 , Cliff Rosendahl  1   7
Affiliations

Practitioner characteristics, diagnostic accuracy metrics and discovering-individual with respect to 637 melanomas documented by 27 general practitioners on the Skin Cancer Audit Research Database

Martelle Coetzer-Botha et al. Australas J Dermatol. 2023 Aug.

Abstract

Background and objective: Knowledge of accuracy for melanoma diagnosis and melanoma discovering-individual in primary care is limited. We describe general practitioner (GP) characteristics and analyse defined diagnostic accuracy metrics for GPs in the current study comparing this with a previous study for GPs common to both, and we analyse the individual first discovering each melanoma as a lesion of concern.

Methods: The characteristics and diagnostic accuracy of 27 Australasian GPs documenting 637 melanomas on the Skin Cancer Audit Research Database (SCARD) in 2013 were described and analysed. The number needed to treat (NNT) and percentage of melanomas that were in situ (percentage in situ) were analysed as surrogates for specificity and sensitivity, respectively. The discovering-individual was analysed according to patient age and sex and lesion Breslow thickness.

Results: The average NNT and percentage in situ were 5.73% and 65.07%, respectively. For 21 GPs in both a 2008-2010 study and the current study, the NNT was 10.78 and 5.56, respectively (p = 0.0037). A consistent trend of decreasing NNT and increasing percentage in situ through increasingly subspecialised GP categories did not reach statistical significance. NNT trended high at ages and sites for which melanoma was rare. While the patient or family member was more likely to discover thick melanomas and melanomas in patients under 40 years, GPs discovered 73.9% of the melanomas as lesions of concern.

Conclusions: GPs were the discovering-individuals for the majority of melanomas in the current study and their accuracy metrics compared favourably with published figures for dermatologists and GPs.

Keywords: NNT; SCARD; general practice; general practitioner; melanoma; melanoma diagnostic accuracy; melanoma in situ/melanoma ratio; number needed to treat; primary care.

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References

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