General practitioners' estimates of the ideal benign-to-malignant ratio for excised pigmented lesions

The effect of an educational programme to improve the skills of general practitioners in diagnosing melanocytic/pigmented lesions

BACKGROUND

Skin cancer is a major public health issue in fair-skinned populations, and general practitioners (GPs) play an important role in the diagnosis and management of this disease.

AIMS

To evaluate a self-instructional education module with audit and feedback, designed to increase the skills of GPs in diagnosing melanocytic lesions and skin cancer.

METHODS

This study, conducted in Queensland, Australia, included 16 GPs who participated in an 18-month programme, comprising a 6-month baseline audit of skin excisions, a 6-month educational programme and a 6-month posteducation audit.

RESULTS

The overall diagnostic accuracy of malignant lesions was 63.2% (95% CI 60.0-66.3) during baseline and 64.5% (95% CI 61.1-67.7) posteducation. Significant improvements were seen posteducation in the proportion of melanocytic lesions confirmed as malignant (6.1% baseline and 13.5% posteducation, chi(2) = 6.6, P = 0.01). GPs with < 15 years of practice recorded significantly lower levels of diagnostic accuracy at baseline compared with those with >/= 25 years of practice (P = 0.001). There were no differences in diagnostic skill posteducation according to years of practice.

CONCLUSIONS

The education programme improved the malignant : benign ratio of melanocytic lesions, resulting in a doubling in the number of melanomas diagnosed. We found that GPs with less experience benefited most from the programme, indicating that tailoring of programmes to individual skills and years of practice might be beneficial.