Using the 7-point checklist as a diagnostic aid for pigmented skin lesions in general practice: a diagnostic validation study
Open accessAbstract
BACKGROUND: GPs need to recognise significant pigmented skin lesions, given rising UK incidence rates for malignant melanoma. The 7-point checklist (7PCL) has been recommended by NICE (2005) for routine use in UK general practice to identify clinically significant lesions which require urgent referral. AIM: To validate the Original and Weighted versions of the 7PCL in the primary care setting. DESIGN AND SETTING: Diagnostic validation study, using data from a SIAscopic diagnostic aid randomised controlled trial in eastern England. METHOD: Adults presenting in general practice with a pigmented skin lesion that could not be immediately diagnosed as benign were recruited into the trial. Reference standard diagnoses were histology or dermatology expert opinion; 7PCL scores were calculated blinded to the reference diagnosis. A case was defined as a clinically significant lesion for primary care referral to secondary care (total 1436 lesions: 225 cases, 1211 controls); or melanoma (36). RESULTS: For diagnosing clinically significant lesions there was a difference between the performance of the Original and Weighted 7PCLs (respectively, area under curve: 0.66, 0.69, difference = 0.03, P<0.001). For the identification of melanoma, similar differences were found. Increasing the Weighted 7PCL's cut-off score from recommended 3 to 4 improved detection of clinically significant lesions in primary care: sensitivity 73.3%, specificity 57.1%, positive predictive value 24.1%, negative predictive value 92.0%, while maintaining high sensitivity of 91.7% and moderate specificity of 53.4% for melanoma. CONCLUSION: The Original and Weighted 7PCLs both performed well in a primary care setting to identify clinically significant lesions as well as melanoma. The Weighted 7PCL, with a revised cut-off score of 4 from 3, performs slightly better and could be applied in general practice to support the recognition of clinically significant lesions and therefore the early identification of melanoma.
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The revised 'Glasgow' 7-point checklist was developed and recently validated in a U.K. primary care population.
“particularly for use in the U.K. population where it was developed and recently validated in a primary care population.29”
From Smartphone applications for melanoma detection by community, patient and generalist clinician users: a review (2015) · cites this paper as [29]
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- Authors
- Walter, F. M., Prevost, A. T., Vasconcelos, J., Hall, P. N., Burrows, N. P., Morris, H. C., Kinmonth, A. L., & Emery, J. D.
- Affiliations
- University of Cambridge (GB)
- King's College London (GB)
- Cambridge University Hospitals NHS Foundation Trust (GB)
- The University of Western Australia (AU)
- ORCID
- Venue
- British Journal of General Practice
- Published
- 2013-05
- Volume
- 63
- Issue
- 610
- Pages
- e345-e353
- ISSN
- 0960-1643 (ISSN-L)
- 1478-5242
- PMC
- PMC3635581
- OpenAlex
- W2125581910
- Cited by
- 95
- References
- 23
- Citations by year
- 2026: 5 · 2025: 9 · 2024: 10 · 2023: 11 · 2022: 5 · 2021: 6 · 2020: 10 · 2019: 9 · 2018: 10 · 2017: 7 · 2016: 3 · 2015: 5 · 2014: 2 · 2013: 1 · 2012: 1
- FWCI
- 1.96
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- British Journal of General Practice (publishedVersion)
- Europe PMC (PubMed Central) (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Research Portal (King's College London) (submittedVersion, other-oa)
- UWA Profiles and Research Repository (UWA) (submittedVersion)
- Funders
- National Institute for Health and Care Research (NF-SI-0508-10072)
- Topics
- Health Sciences › Medicine › Oncology › Cutaneous Melanoma Detection and Management
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Cell Biology › melanin and skin pigmentation
- Health Sciences › Medicine › Dermatology › Cancer and Skin Lesions
- Keywords
- pigmented skin lesions, melanoma, diagnostic accuracy, primary care referral, cut-off values, early melanoma detection, general practice
- MeSH terms
- Adult, England, Female, Humans, Male, Melanoma, Middle Aged, Pigmentation Disorders, Primary Health Care, Referral and Consultation, Sensitivity and Specificity, Skin Neoplasms, Checklist, General Practice
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
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