Aid to diagnosis of melanoma in primary medical care

BMJ 1995;310:492-495 (25 February)

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Aid to diagnosis of melanoma in primary medical care

Christopher B Del Mar, reader in general practice,^a Adele C Green, principal research fellow ^b

^a University of Queensland Medical School, Brisbane, Queensland 4006, Australia, ^b Queensland Institute of Medical Research, Brisbane, Queensland 4029, Australia

Correspondence to: Dr Del Mar.

Abstract

Objective: To evaluate an intervention designed to reduce thenumber of benign melanocytic lesions excised from the skin.
Design: A randomised controlled field trial based in the medicalpractices of two cities. Examination of histopathological reportsof 5823 melanocytic skin lesions excised over the interventionperiod and in the preceding six months
Intervention: Medical practitioners were offered an algorithmand use of an instant developing camera.
Setting and subjects: Over 50 medical practitioners, mostlyin general practice, in each of two cities in tropical Queensland,Australia.
Main outcome measures: Percentages of benign (neither malignantnor potentially malignant) melanocytic lesions excised duringthe two year intervention period.
Results: There were no significant differences in the percentagesof benign lesions reported in the intervention and control citiesbefore the intervention started (93.6% and 94.0%, respectively),but there was a significant difference afterwards (88.8% and93.8%, P<0.001). There was no difference in the percentageof invasive melanomas excised per month in the interventioncity (3.4%) compared with control city (3.4%).
Conclusion: Clinical diagnostic accuracy may be enhanced byoffering to clinicians managing suspicious melanocytic skinlesions a simple algorithm and a camera with which to recordthe appearance of lesions objectively.

Key messages

Key messages
To avoid missing a diagnosis of melanoma many benign pigmented skin lesions are excised
Unless obviously malignant initially a lesion for which malignancy cannot be excluded may be watched if its size and appearance can be accurately recorded so that any change is detected with follow up
An instant camera and a simple algorithm may reduce false positive excisions without increasing false negative diagnoses in populations susceptible to malignant melanoma
Use of an instant camera and an algorithm is relatively easy to incorporate into usual clinical practice

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