NEW ORLEANS Dermatologists diagnosed nearly twice the number of neoplastic and cystic skin lesions correctly as did nondermatologist physicians, according to research presented at the annual meeting of the American Academy of Dermatology.
Dermatologists were right 75% of the time when diagnosing neoplastic and cystic skin lesions, compared with nondermatologist physicians, who were right about 40% of the time. The research was conducted by Klaus Sellheyer, M.D., and Wilma Bergfeld, M.D., of the Cleveland Clinic Foundation.
The researchers reviewed 4,451 skin specimens submitted to their dermatopathology clinic between Jan. 1, 2004, and March 31, 2004. The specimens were submitted by 37 dermatologists and 162 nondermatologists, including plastic surgeons, family physicians, internists, pediatricians, surgeons, and others.
The clinical diagnosis submitted by family physicians for neoplastic and cystic skin lesions matched the histopathologic diagnosis in 26% of cases, the researchers found.
Plastic surgeons, who performed the largest number of cutaneous surgical procedures among the nondermatologists, did better in recognizing skin tumors but still had a diagnostic accuracy rate of 45%.
For inflammatory skin diseases, dermatologists were correct in their diagnoses in about 71% of cases, compared with nondermatologists, who were right in about 34% of cases, the researchers found.
The researchers recommended that nondermatologists continue to perform skin biopsies, but only if they have acquired enough knowledge of basic dermatology and dermatopathology. This type of knowledge is important not only in correctly performing skin biopsies, they said, but in avoiding unnecessary invasive biopsy procedures.
Eric B. Larson, M.D., an internist in Seattle, and chair of the American College of Physicians' Board of Regents, said he's not too surprised by the findings. And he said they are important because they point to the need for internists to acquire and maintain the necessary dermatology skills.
For some physicians, that may mean shadowing a dermatologist to hone biopsy skills. "The key thing is to keep up the skill," Dr. Larson said.
Mary Frank, M.D., president of the American Academy of Family Physicians, said it's key for family physicians to be able to recognize whether a skin lesion is suspicious and should be biopsied. Having that level of suspicion is key to ensuring that patients get the right diagnosis and treatment, she said.
But it's less important that family doctors pinpoint the right diagnosis before sending the results off to the lab, she said.