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A Study of Primary Care Physicians in Queensland, Australia

Peter D. Baade, PhD; Philippa H. Youl, MPH; Monika Janda, PhD; David C. Whiteman, PhD; Christopher B. Del Mar, MD; Joanne F. Aitken, PhD

Arch Dermatol. 2008;144(11):1468-1476.

Objective  To assess physician, patient, and skin lesion characteristics that affect the number of benign skin lesions excised by primary care physicians for each skin cancer.

Design  Prospective study collecting clinical, patient, and histopathologic details of excisions or biopsies of skin lesions by random samples of primary care physicians.

Setting  Southeast Queensland involving traditional family medicine physicians (n = 104; response rate, 53.9%) and family medicine physicians working in 27 primary care skin cancer clinics (n = 50; response rate, 75.0%).

Participants  Of 28 755 skin examinations recorded during the study, 11 403 skin lesions were excised or biopsied; 97.5% of the excised lesions had clinical and histologic diagnoses recorded.

Main Outcome Measures  Number of lesions needed to excise or biopsy (NNE) for 1 melanoma (pigmented lesions only) and NNE for 1 nonmelanoma skin cancer (nonpigmented lesions only).

Results  The NNE for nonpigmented lesions (n = 8139) was 1.5 (95% confidence interval, 1.4-1.6) and for pigmented lesions (n = 2977) was 19.6 (16.2-22.9). The NNE estimates were up to 8 times lower if the physician thought the lesion was likely to be malignant and up to 2.5 times higher if there was strong patient pressure to excise. The NNE estimates varied by other physician-, patient-, and lesion-related variables.

Conclusions  Clinical impressions of excised skin lesions were strongly associated with NNE estimates. By focusing on pigmented skin lesions and by addressing the physician- and patient-specific factors identified, the effectiveness of future training for primary care physicians in the clinical management of skin cancer could be improved.

Author Affiliations: Viertel Centre for Research in Cancer Control, Cancer Council Queensland, Spring Hill (Drs Baade and Aitken and Ms Youl); School of Public Health (Dr Baade) and Institute of Health and Biomedical Innovation, Faculty of Health (Dr Janda), Queensland University of Technology, Kelvin Grove; Queensland Institute of Medical Research, Herston (Dr Whiteman); Faculty of Health Science and Medicine, Bond University, Gold Coast (Dr Del Mar), Queensland, Australia; and School of Population Health, University of Queensland, Brisbane, Australia (Dr Aitken).

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