Diagnosing and managing cutaneous pigmented lesions: primary care physicians versus dermatologists.
Open accessAbstract
Background Primary care physicians (PCPs) are often expected to screen for melanomas and refer patients with suspicious pigmented lesions to dermatologists.Objective To assess whether there is a difference between dermatologists and PCPs in accurately diagnosing melanoma and appropriately managing (based on decisions to refer/biopsy) suspicious pigmented lesions.Design, participants A survey based on a random sample of 30 photographs of pigmented lesions with known pathology was administered to 101 dermatologists and 115 PCPs from October 2001 to January 2003.Measurements Likelihoods that a photographed lesion was melanoma and that the lesion should be biopsied/referred were scored on a 1 to 10 scale. Accuracy of melanoma diagnosis and appropriateness of pigmented lesion management were compared between dermatologists and PCPs by using the areas under (AUC) the receiver operating characteristic (ROC) curves.Results Dermatologists were superior to PCPs in diagnosing melanomas (AUC 0.89 vs 0.80, P<.001) and appropriately managing pigmented lesions (AUC .84 vs 0.76, P<.001). PCPs who tended to biopsy lesions themselves did better at managing pigmented lesions than PCPs who did not perform biopsies. Dermatology training during residency did not significantly improve the diagnostic accuracy of PCPs nor their management of pigmented lesions.Conclusions Dermatologists have both better diagnostic accuracy and ability to manage pigmented lesions than PCPs. Yet, there is a shortage of dermatologists to meet the demand of accurate melanoma screening. More innovative strategies are needed to better train PCPs and enhance skin cancer screening.
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Examination of some skin conditions by dermatologists results in significantly higher diagnostic accuracy and is associated with better clinical outcomes than nondermatologist examination.
“The examination of some skin conditions by dermatologists results in significantly higher diagnostic accuracy2,3,4 and is associated with better clinical outcomes5 than nondermatologist examination.”
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- Authors
- Chen, S. C., Pennie, M. L., Kolm, P., Warshaw, E. M., Weisberg, E. L., Brown, K. M., Ming, M. E., & Weintraub, W. S.
- Affiliations
- Emory University (US)
- Christiana Care Health System (US)
- University of Minnesota (US)
- The University of Texas Southwestern Medical Center (US)
- Brown University (US)
- University of Pennsylvania (US)
- Corresponding author
- Chen, Suephy C.
- ORCID
- Venue
- Journal of General Internal Medicine
- Published
- 2006-07
- Volume
- 21
- Issue
- 7
- Pages
- 678-682
- ISSN
- 0884-8734 (ISSN-L)
- 1525-1497
- PMC
- PMC1924688
- OpenAlex
- W1968877564
- Cited by
- 122
- References
- 28
- Citations by year
- 2026: 3 · 2025: 2 · 2024: 5 · 2023: 6 · 2022: 3 · 2021: 6 · 2020: 6 · 2019: 5 · 2018: 6 · 2017: 7 · 2016: 2 · 2015: 7 · 2014: 9 · 2013: 8 · 2012: 7
- FWCI
- 3.64
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Journal of General Internal Medicine (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Institute of Arthritis and Musculoskeletal and Skin Diseases (K23AR02185-01A1, K23AR002185)
- Topics
- Health Sciences › Medicine › Oncology › Cutaneous Melanoma Detection and Management
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Cell Biology › melanin and skin pigmentation
- Social Sciences › Business, Management and Accounting › Organizational Behavior and Human Resource Management › Healthcare Systems and Technology
- Keywords
- melanoma diagnosis, primary care physicians, dermatologists, diagnostic accuracy, skin cancer screening, biopsy decision, referral decisions, physician training, dermatology residency training, physician shortage
- MeSH terms
- Biopsy, Dermatology, Family Practice, Female, Humans, Internal Medicine, Male, Physicians, Family, Pigmentation Disorders, Skin Diseases, Reproducibility of Results, Treatment Outcome
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