The impact of subspecialization
SCARD in the Journal of the American Academy of Dermatology
The impact of subspecialization and dermatoscopy use on accuracy of melanoma diagnosis among primary care doctors in Australia
Authors: Cliff Rosendahl, MBBS, Gail Williams, PhD, Diann Eley, PhD, Tobias Wilson, Candidate BSc, Greg Canning, MMed, Jeffrey Keir, MBBS, Ian McColl, FACD, and David Wilkinson, DSc
ABSTRACT
Background
Dermatoscopy improves accuracy of melanoma diagnosis, but the impact of subspecialization in skin cancer practice among general practitioners on melanoma diagnostic accuracy is not known.
Objectvie
To assess the impact of dermatoscopy use and subspecialization on the accuracy of melanoma diagnosis by general practitioners.
Methods
We performed a prospective study on the Skin Cancer Audit Research Database and measured melanoma ‘number needed to treat’ (NNT), with 21,900 lesions excised to diagnose 2367 melanomas.
Results
Melanoma NNT fell from a high of 17.0 (95% con?dence interval [CI] 14.5-20.7) among general practitioners with a generalist practice to 9.4 (CI 8.9-10.1) among those with a speci?c interest in skin cancer, and 8.5 (CI 8.1-9.0) among those practicing only skin cancer medicine (P\.0001). Melanoma NNT fell from a high of 14.6 (CI 12.0-18.6) among dermatoscopy low/non-users to 10.9 (CI 9.8-12.4) among medium users, and 8.9 (CI 8.6-9.3) among high users (P \.0001). The association between NNT and practice type remained (P \.0001) when adjusted for dermatoscopy use and other variables. The association between NNT and dermatoscopy use disappeared (P = .41) when adjusted for practice type and other variables.
Conclusions
Dermatoscopy improves accuracy of melanoma diagnosis, but the impact of subspecialization in skin cancer practice among general practitioners on melanoma diagnostic accuracy is not known.
Links
View the article online at http://www.sciencedirect.com/science/article/pii/S0190962212000072
Listings
This article is referenced by the following directories:
- https://www.ncbi.nlm.nih.gov/pubmed/22325462
- http://www.jaad.org/article/S0190-9622(12)00007-2/abstract?cc=y=
- http://www.researchonline.mq.edu.au/vital/access/manager/Repository/mq:27855
- http://f1000.com/prime/13949975
- http://www.academia.edu/24870607/The_impact_of_subspecialization_and_dermatoscopy_use_on_accuracy_of_melanoma_diagnosis_among_primary_care_doctors_in_Australia
© 2012 The Journal of the American Academy of Dermatology.