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.
NNT
SCARD
general practice
general practitioner
melanoma
melanoma diagnostic accuracy
melanoma in situ/melanoma ratio
number needed to treat
primary care
Journal
The Australasian journal of dermatology
ISSN: 1440-0960
Titre abrégé: Australas J Dermatol
Pays: Australia
ID NLM: 0135232
Informations de publication
Date de publication:
Aug 2023
Aug 2023
Historique:
revised:
07
04
2023
received:
18
01
2023
accepted:
12
04
2023
medline:
11
8
2023
pubmed:
24
4
2023
entrez:
24
04
2023
Statut:
ppublish
Résumé
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. 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. 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. 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.
Sections du résumé
BACKGROUND AND OBJECTIVE
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
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
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
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.
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
378-388Informations de copyright
© 2023 The Authors. Australasian Journal of Dermatology published by John Wiley & Sons Australia, Ltd on behalf of Australasian College of Dermatologists.
Références
Welfare AIoHa. Cancer rankings data visualisation. Australian Government. 2022. [cited 2022 15 January 2023]. Available from: https://www.aihw.gov.au/reports/cancer/cancer-data-in-australia/contents/cancer-rankings-data-visualisation
Elwood JM, Kim SJH, Ip KHK, Oakley A, Rademaker M. In situ and invasive melanoma in a high-risk, New Zealand, population: a population-based study. Australas J Dermatol. 2019;60(1):38-44.
Wu A, Rosen R, Selva D, Huilgol SC. Proportion of melanoma excisions performed by different specialties in Australia. Australas J Dermatol. 2018;59(3):243-5.
Rosendahl C, Hansen C, Cameron A, Bourne P, Wilson T, Cook B, et al. Measuring performance in skin cancer practice: the SCARD initiative. Int J Dermatol. 2011;50(1):44-51.
Rosendahl CM, Williams GP, Eley DP, Wilson TCB, Canning GM, Keir JM, et al. The impact of subspecialization and dermatoscopy use on accuracy of melanoma diagnosis among primary care doctors in Australia. J Am Acad Dermatol. 2012;67(5):846-52.
Green AC, Pandeya N, Morton S, Simonidis J, Whiteman DC. Early detection of melanoma in specialised primary care practice in Australia. Cancer Epidemiol. 2021;70:101872. https://doi.org/10.1016/j.canep.2020.101872.7
Marsden JR, Newton-Bishop JA, Burrows L, Cook M, Corrie PG, Cox NH, et al. Revised U.K. guidelines for the management of cutaneous melanoma 2010: bad guidelines. Br J Dermatol (1951). 2010;163(2):238-56.
Ahmadi K, Prickaerts E, Smeets JGE, Joosten VHMJ, Kelleners-Smeets NWJ, Dinant GJ. Current approach of skin lesions suspected of malignancy in general practice in The Netherlands: a quantitative overview. J Eur Acad Dermatol Venereol. 2018;32(2):236-41.
Weinstock MA. Early detection of melanoma. JAMA. 2000;284(7):886-9.
Marchetti MA, Yu A, Nanda J, Tschandl P, Kittler H, Marghoob AA, et al. Number needed to biopsy ratio and diagnostic accuracy for melanoma detection. J Am Acad Dermatol. 2020;83(3):780-7.
Chia ALK, Simonova G, Dutta B, Lim A, Shumack S. Melanoma diagnosis: Australian dermatologists' number needed to treat. Australas J Dermatol. 2008;49(1):12-5.
Argenziano GMD, Cerroni LMD, Zalaudek IMD, Staibano SMD, Hofmann-Wellenhof RMD, Arpaia NMD, et al. Accuracy in melanoma detection: a 10-year multicenter survey. J Am Acad Dermatol. 2011;67(1):54-9.e1.
Wilson RL, Yentzer BA, Isom SP, Feldman SR, Fleischer AB Jr. How good are US dermatologists at discriminating skin cancers? A number-needed-to-treat analysis. J Dermatolog Treat. 2012;23(1):65-9.
Esdaile B, Mahmud I, Palmer A, Bowling J. Diagnosing melanoma: how do we assess how good we are? Clin Exp Dermatol. 2014;39(2):129-34.
Jimenez Balcells C, Hay J, Keir J, Rosendahl N, Coetzer-Botha M, Wilson T, et al. Characteristics of 637 melanomas documented by 27 general practitioners on the skin cancer audit research database. Aust J Dermatol. 2021;62(4):496-503. https://doi.org/10.1111/ajd.13705
Hay J, Keir J, Jimenez Balcells C, Rosendahl N, Coetzer-Botha M, Wilson T, et al. Characteristics, treatment and outcomes of 589 melanoma patients documented by 27 general practitioners on the skin cancer audit research database. Aust J Dermatol. 2022;63(2):204-12. https://doi.org/10.1111/ajd.13843.17
Fisher RA. Statistical methods for research workers. In: Kotz S, Johnson NL, editors. Breakthroughs in statistics: methodology and distribution. New York, NY: Springer New York; 1992. p. 66-70.
Petty AJ, Ackerson B, Garza R, Peterson M, Liu B, Green C, et al. Meta-analysis of number needed to treat for diagnosis of melanoma by clinical setting. J Am Acad Dermatol. 2020;82(5):1158-65.
Rosendahl C, Cameron A, Wilkinson D, Belt P, Williamson R, Weedon D. Nail matrix melanoma: consecutive cases in a general practice. Dermatol Pract Concept. 2012;2(2):202a13.
Babino G, Lallas A, Agozzino M, Alfano R, Apalla Z, Brancaccio G, et al. Melanoma diagnosed on digital dermoscopy monitoring: a side-by-side image comparison is needed to improve early detection. J Am Acad Dermatol. 2021;85(3):619-25.
Australia CC. Clinical practice guidelines for the diagnosis and management of melanoma. 2022. [25/11/2022]. Available from: https://wiki.cancer.org.au/australia/Guidelines:Melanoma
Inskip M, Cameron A, Akay BN, Gorji M, Clark SP, Rosendahl N, et al. Dermatoscopic features of pigmented intraepidermal carcinoma on the head and neck. J Dtsch Dermatol Ges. 2020;18(9):969-76.
Morton DL, Thompson JF, Cochran AJ, Mozzillo N, Nieweg OE, Roses DF, et al. Final trial report of sentinel-node biopsy versus nodal observation in melanoma. N Engl J Med. 2014;370(7):599-609.
Whiteman DC, Olsen CM, MacGregor S, Law MH, Thompson B, Dusingize JC, et al. The effect of screening on melanoma incidence and biopsy rates. Br J Dermatol. 2022;187(4):515-22.
Frangos JEMD, Duncan LMMD, Piris AMD, Nazarian RMMD, Mihm MCMD, Hoang MPMD, et al. Increased diagnosis of thin superficial spreading melanomas: a 20-year study. J Am Acad Dermatol. 2011;67(3):387-94.