Differences in diagnostic accuracy between GPs and specialists in the management of skin cancer
Journal Publication ResearchOnline@JCUAbstract
Background: Skin cancer is an increasing problem in fair-skinned populations world-wide. In north Queensland the majority of skin cancer is managed initially by general practitioners (GPs). It is important that doctors are able to diagnose skin lesions accurately. There are limited studies comparing the diagnostic accuracy of GPs and specialists. The objective of this report is to compare diagnostic agreement based on histopathology between GPs and specialists. Methods: All excised and histologically confirmed skin cancers in Townsville/Thuringowa, Australia were recorded between December 1996 and October 1999. Clinical diagnoses were recorded and compared to histological diagnoses. Positive predictive values (PPVs) and sensitivities were calculated for the clinical diagnoses and stratified by histological subtype. The results were then compared between the GPs and specialists. Results: A total of 193 doctors – 174 GPs and 19 specialists - were recorded in the database. Only one of the 19 specialists was a dermatologist. Of the 8,694 first excisions, 1443 lesions (16.6%) were treated by specialists, the rest by GPs. For basal cell carcinoma, positive predictive value was significantly higher for specialists compared to GPs (81.2% versus 70.6%, p<0.001). For squamous cell carcinoma, common naevi and seborrhoeic keratosis sensitivity was significantly higher for GPs than for specialists (42.2% versus 34.6%; p=0.005, 42.9% versus 30.5% p=0.036 and12.9% versus 4.3% p=0.018, respectively). Conclusions: In the present analysis, although specialists had higher accuracy in the diagnosis of basal cell carcinomas, GPs were more accurate in the diagnosis of squamous cell carcinoma, common naevi and seborrhoic keratosis. Overall there was little difference in the diagnostic performance between the two groups of doctors. These findings contrast with previous studies which have found the diagnostic performance of specialists to be superior to that of GPs. It is possible that this improved diagnostic performance may be a reflection of the higher caseload of skin cancer experienced by GPs in North Queensland
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9
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1832-2921
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5
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School of Public Health, James Cook University
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