NEW ORLEANS — Dermatologists diagnosed nearly twice the number of neoplastic and cystic skin lesions correctly than 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 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.
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 the right diagnosis and treatment, she said.
But she said it's less important that family doctors pinpoint the right diagnosis before sending the results off to the lab.
Physicians should be able to recognize suspicious lesions that could be skin cancer or those that may point to another health problem, such as the skin changes associated with lupus, she said.
Dr. Frank agreed it is important for family physicians and other nondermatologists to be appropriately trained in dermatology and skin biopsy. But she said dermatology and biopsy techniques are already part of family medicine residency training.
In addition, if a family physician isn't comfortable performing a biopsy on a lesion of concern, he or she should refer the patient to another physician—such as a family physician colleague, a dermatologist, or another subspecialist.