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A Systematic Review

Suephy C. Chen, MD, MS; Dena M. Bravata, MD, MS; Evette Weil, BS; Ingram Olkin, PhD

Arch Dermatol. 2001;137:1627-1634.

Objective  To compare the accuracy of dermatologists and primary care physicians (PCPs) in identifying pigmented lesions suggestive of melanoma and making the appropriate management decision to perform a biopsy or to refer the patient to a specialist.

Data Sources  Studies published between January 1966 and October 1999 in the MEDLINE, EMBASE, and CancerLit databases; reference lists of identified studies; abstracts from recent conference proceedings; and direct contact with investigators. Medical subject headings included melanoma, diagnosis, screening, primary care, family practitioner, general practitioner, internal medicine, dermatologist, and skin specialist. Articles were restricted to those involving human subjects.

Study Selection  Studies that presented sufficient data to determine the sensitivity and specificity of dermatologists' or PCPs' ability to correctly diagnose lesions suggestive of melanoma and to perform biopsies on or refer patients with such lesions.

Data Extraction  Two reviewers independently abstracted data regarding the sensitivity and specificity of the dermatologists and PCPs for diagnostic and biopsy or referral accuracy. Disagreements were resolved by discussion. The quality of the studies was also evaluated.

Data Synthesis  Thirty-two studies met inclusion criteria; 10 were prospective studies. For diagnostic accuracy, sensitivity was 0.81 to 1.00 for dermatologists and 0.42 to 1.00 for PCPs. None of the studies reported specificity for dermatologists; one reported specificity for PCPs (0.98). For biopsy or referral accuracy, sensitivity ranged from 0.82 to 1.00 for dermatologists and 0.70 to 0.88 for PCPs; specificity, 0.70 to 0.89 for dermatologists and 0.70 to 0.87 for PCPs. Receiver operating characteristic curves for biopsy or referral ability were inconclusive.

Conclusions  The published data are inadequate to demonstrate differences in dermatologists' and PCPs' diagnostic and biopsy or referral accuracy of lesions suggestive of melanoma. We offer study design suggestions for future studies.

From the Department of Dermatology, Emory Center for Outcomes Research, Emory University School of Medicine, Atlanta, Ga (Dr Chen); Veterans Affairs Palo Alto Health Care System, Palo Alto, Calif (Dr Bravata); Center for Primary Care and Outcomes Research, Department of Medicine, Stanford University School of Medicine, Stanford, Calif (Dr Bravata); School of Medicine, University of Toronto, Toronto, Ontario (Ms Weil); and Department of Statistics, School of Education, Stanford University, Stanford (Dr Olkin).

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