Examination of skin naevi in Australian general practice: dissonance between care and need?

Do Dermatologic Diagnosis Change in Hot vs. Cold Periods of The Year? A Sub-Analysis of the DIADERM National Sample (Spain 2016)

BACKGROUND

Knowledge of seasonal variation of cutaneous disorder may be useful for heath planning and disease management. To date, however, descriptions of seasonality including all diagnoses in a representative country sample are very scarce.

OBJECTIVES

To evaluate if clinical dermatologic diagnosis in Spain change in the hot vs. cold periods.

MATERIALS AND METHODS

Survey based on a random sample of dermatologists in Spain, stratified by area. Each participant collected data during 6 days of clinical activity in 2016 (3 in the cold period of the year, 3 in the hot period). Clinical diagnoses were coded using ICD-10.

RESULTS

With a 62% response proportion, we got data on 10999 clinical diagnoses. ICD-10 diagnostic groups that showed changes were: other benign neoplasms of skin (D23), rosacea (L71) and other follicular disorders (L73), which were more common in the hot period and acne (L70) which was more frequent in the cold period. We describe differences in the paediatric population and in private vs. public practice. Some of these differences might be associated to differences in the population demanding consultations in different periods.

CONCLUSIONS

The frequency of most clinical diagnosis made by dermatologists does not change over the year. Just a few of the clinical diagnoses made by dermatologists show a variation in hot vs. cold periods. These variations could be due to the diseases themselves or to seasonal changes in the demand for consultation.

Diagnosing skin cancer in primary care: how do mainstream general practitioners compare with primary care skin cancer clinic doctors?

OBJECTIVE

To measure and compare the casemix and diagnostic accuracy of excised or biopsied skin lesions managed by mainstream general practitioners and doctors within primary care skin cancer clinics.

DESIGN, SETTING AND PARTICIPANTS

Prospective comparative study of 104 GPs and 50 skin cancer clinic doctors in south-eastern Queensland, involving 28 755 patient encounters. The study was conducted in 2005.

MAIN OUTCOME MEASURES

Prevalence of each type of skin lesion; sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) for the clinical diagnosis against histology; number needed to excise or biopsy (NNE) for a diagnosis of skin cancer.

RESULTS

GPs excised or biopsied 3175 skin lesions (mean 2.5/week) including 743 basal cell carcinomas (BCCs) (23.4%), 704 squamous cell carcinomas (SCCs) (22.2%) and 49 melanomas (1.5%). Skin cancer clinic doctors excised or biopsied 7941 skin lesions (mean 34/week), including 2701 BCCs (34.0%), 1274 SCCs (16.0%) and 103 melanomas (1.3%). Overall, sensitivity for diagnosing any skin cancer was similar for skin cancer clinic doctors (0.94) and GPs (0.91), although higher for skin cancer clinic doctors for BCC (0.89 v 0.79; P < 0.01) and melanoma (0.60 v 0.29; P < 0.01). The overall NNE was similar for skin cancer clinic doctors (1.9; 95% CI, 1.8%-2.1%) and GPs (2.1; 95% CI, 1.9%-2.3%). This did not change after adjusting for years of clinical experience.

CONCLUSIONS

GPs and skin cancer clinic doctors in Queensland treat large numbers of skin cancers and diagnose these with overall high sensitivity. The two groups diagnosed skin cancer with similar accuracy.