Baade Peter D, Balanda Kevin P, Stanton Warren R, Lowe John B, Del Mar Chris B
Viertel Centre for Research in Cancer Control, Queensland Cancer Fund, P.O. Box 201, Spring Hill, Qld 4004, Australia.
Cancer Detect Prev. 2005;29(3):267-75. doi: 10.1016/j.cdp.2004.06.007. Epub 2004 Dec 10.
Community responses (n=925, response rate=71%) of a series of eight photographs of pigmented skin lesions were compared against those of general practitioners (n=114, response rate=77%), considered to be the most relevant gold standard. The eight photographs included three melanomas, two potentially malignant lesions and three benign pigmented lesions. Over the pool of lesions examined, the average probability that community members thought a lesion was likely to be skin cancer (0.68 [99% CI=0.66-0.69]) was higher (p<0.0001) than that of the comparison general practitioners 0.58 [99% CI=0.55-0.62]. This reflects a general (but not consistent) inflated propensity to over-diagnose among community members. The average probability that respondents indicated they would seek medical advice for a lesion was 0.71 [99% CI=0.70-0.73]. As expected, this was strongly associated with their perceptions of the skin lesion. These results suggest that the community can play a valuable role in assessing the need for medical evaluation of pigmented skin lesions.
将一系列八张色素沉着性皮肤病变照片的社区反馈（n = 925，回复率 = 71%）与全科医生的反馈（n = 114，回复率 = 77%）进行了比较，全科医生的反馈被视为最相关的金标准。这八张照片包括三个黑色素瘤、两个潜在恶性病变和三个良性色素沉着性病变。在所有检查的病变中，社区成员认为病变可能是皮肤癌的平均概率为0.68[99%置信区间 = 0.66 - 0.69]，高于（p < 0.0001）作为对照的全科医生的概率0.58[99%置信区间 = 0.55 - 0.62]。这反映出社区成员普遍（但并非始终一致）存在过度诊断的倾向。受访者表示他们会就病变寻求医疗建议的平均概率为0.71[99%置信区间 = 0.70 - 0.73]。正如预期的那样，这与他们对皮肤病变的认知密切相关。这些结果表明，社区在评估色素沉着性皮肤病变的医学评估需求方面可以发挥重要作用。
