General Practice Clinical Unit, Medical School, The University of Queensland, St Lucia, Queensland, Australia.
4D Skin Cancer Clinic, Belmont North, New South Wales, Australia.
Australas J Dermatol. 2023 Aug;64(3):378-388. doi: 10.1111/ajd.14061. Epub 2023 Apr 24.
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.
初级保健中，对黑色素瘤诊断和黑色素瘤发现个体的准确性知识有限。我们描述了全科医生（GP）的特征，并分析了本研究中比较这两项研究的 27 名 GP 的特定诊断准确性指标，还分析了每位 GP 作为关注病变首次发现的每个黑色素瘤的个体。
描述并分析了 2013 年在皮肤癌审计研究数据库（SCARD）上记录了 637 例黑色素瘤的 27 名澳大利亚全科医生的特征和诊断准确性。分别分析需要治疗的数量（NNT）和原位黑色素瘤的百分比（原位百分比）作为特异性和敏感性的替代指标。根据患者年龄和性别以及病变 Breslow 厚度分析发现个体。
平均 NNT 和原位百分比分别为 5.73%和 65.07%。对于 2008-2010 年研究和本研究中的 21 名 GP，NNT 分别为 10.78 和 5.56（p=0.0037）。随着 GP 亚专科化程度的增加，NNT 降低和原位百分比增加的趋势并未达到统计学意义。在黑色素瘤罕见的年龄和部位，NNT 较高。虽然患者或家属更有可能发现厚的黑色素瘤和 40 岁以下患者的黑色素瘤，但 GP 发现了 73.9%的黑色素瘤作为关注病变。
在本研究中，GP 是大多数黑色素瘤的发现个体，他们的准确性指标与皮肤科医生和 GP 的已发表数据相比表现良好。
