Doctors may be overly cautious, in some cases, when deciding whether or not to remove a pigmented skin lesion to determine whether or not it is malignant, according to research published in the current issue of the Medical Journal of Australia.
Dallas English PhD of the Cancer Council Victoria and colleagues analysed the data on 4,741 pigmented skin lesions removed by 468 general practitioners in Perth. They compared results in terms of the number of lesions that needed to be removed in order to find one melanoma. This figure is referred to as the number needed to treat (NNT).
"A low NNT may mean that diagnostic criteria are too narrow and that melanomas are more likely to be missed. A high NNT may mean that the economic and personal costs of removing lesions are excessive", Dr English said.
Pressure from patients and medico legal worries about "missing" a melanoma were among the factors influencing GPs when deciding whether or not to remove a pigmented skin lesion.
The data indicate that less experienced doctors were likely to remove more benign lesions per melanoma than more experienced doctors. The NNT was higher in younger patients (who had more benign lesions) than older patients. The NNT was also higher in females than males, and highest among patients from socioeconomically disadvantaged areas. The average number of lesions removed to identify one melanoma was 29.
"GPs could increase the number of lesions removed from older and male patients and, conversely, remove fewer lesions from younger and female patients," Dr English said.
The Medical Journal of Australia is a publication of the Australian Medical Association.
CONTACT Dr Dallas English 03 9635 5295 / 0417 091 133
unavailable from 27/12/03-12/1/04
Judith Tokley, AMA 02 6270 5471 / 0408 824 306