Barcelona, 20 April 2006. Primary care physicians (PCP) care for basic health problems of the population and facilitate the referral to specialists, the second level of health care. That is to say, PCPs identify pathologies and help establishing a connection with the health system network. Dermatology is one of the public health areas where the ability of PCPs could contribute with more benefits. A study promoted by researchers of the Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), in collaboration with several Catalan and Italian Primary Care Centres, demonstrates that dermoscopy could increase sensitivity in 25% for the detection of malignant lesions. Three simple dermoscopy classification criteria help PCPs make decisions. Results will be published tomorrow in Journal of Clinical Oncology, in an article signed by several researchers of the IDIBAPS Genetic Factors and Treatment of Malignant Melanoma Group. Previous research works emphasized the benefits of dermoscopy, but its real usefulness had never been demonstrated in the framework of a real health system until now.
Approximately half of the 73 physicians who took part in the study came from the Primary Care Centre CAP Les Corts and from the CAPSE Eixample, centres linked to Hospital Clínic de Barcelona. The other half was formed by physicians from medical centres in Naples (Italy). All of them were trained during a four-hour dermoscopy course and afterwards were randomly divided into two study groups: a group wprking with dermoscope and a second group working without dermoscope. The dermoscope is a small magnifier with an illumination system which permits to visualize the morphological details of a skin lesion. The three criteria given in the course in order to detect possible malignant tumours were: asymmetry of colour or structure, presence of a net of thick lines with irregular distribution and, detection of white and/or blue structures. If two of these criteria are met, the examined lesion is considered potentially malignant and the patient must be referred to a specialist.
During 6 months, the PCPs visited 3,271 patients of skin pathologies. All of them were supervised by a specialised dermatologist. PCPs not applying dermoscopy techniques referred more patients to the specialist, and they overlooked a higher number of potentially malignant lesions. The sensitivity in the detection of these lesions increased from 54.1% to 79.2% if the physician used dermoscopy, and the specificity was maintained. The percent of false negatives was reduced to less than a half, reaching 2%.
Therefore, the use of dermoscopy among PCPs, along with training in the three criteria in order to classify lesions, could mean a reduction of the congestion of specialized offices and a significant improvement in the fight against skin cancer. Dermoscopy is not widespread in Spain, contrarily to what happens in Australia or Germany, where dermoscopy is routinarily applied, and digital imaging techniques are expanding. Nevertheless, this technique, which helps PCPs take decisions, has been naturally included in the daily routine of Primary Care Centres connected to Hospital Clínic which have participated in this study.
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