Comparison of Dermatologists' and Nondermatologists' Diagnostic Accuracy for Malignant Melanoma

BACKGROUND: The incidence of malignant melanoma is increasing annually in Canada and patients present to nondermatologist groups (NDGs) first to have suspicious lesions examined. OBJECTIVE: To determine the ability of Canadian NDGs in the recognition and management of melanoma. METHODS: A survey of 25 malignant and benign skin lesion photographs was distributed to dermatologists and NDGs across Canada. Participants were asked to list whether the lesions were malignant or benign, and could answer 'uncertain' if needed. Dermatologists were subsequently asked if they would biopsy the lesion, whereas NDGs were asked if they would biopsy/refer. RESULTS: Dermatologists achieved mean sensitivities, specificities, and diagnostic accuracies of 0.79, 0.77, and 0.71, respectively. They consistently decided to biopsy malignant lesions. NDGs attained mean scores of 0.61, 0.62, and 0.53, respectively, and selected to refer/biopsy the majority of lesions, malignant and benign. CONCLUSIONS: NDGs should receive more dermatologic training in the recognition of malignant melanoma.