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MANAGEMENT OF SUSPICIOUS MELANOCYTIC LESIONS IN GENERAL PRACTICE
Author(s) -
Robison S. M.,
Kljakovic M.,
Barry P.
Publication year - 2009
Publication title -
anz journal of surgery
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.426
H-Index - 70
eISSN - 1445-2197
pISSN - 1445-1433
DOI - 10.1111/j.1445-2197.2009.04932_4.x
Subject(s) - medicine , guideline , biopsy , referral , medical diagnosis , general practice , surgery , general surgery , family medicine , radiology , pathology
Purpose: General practitioners (GPs) are involved in the management of most melanocytic skin lesions in Australia. A high quality biopsy is crucial in initial management, as it is recognised that poor techniques can mislead, prolong, or miss a diagnosis of melanoma. There has been little published data on the biopsy decisions and techniques of general practitioners. Our study sought to redress this gap by describing how general practitioners make decisions on biopsy and to compare their techniques with current NH and MRC best practice guidelines. Methodology: All GPs working in the Australian Capital Territory region were presented with a survey of three clinical scenarios of increasing complexity in which a referral, or biopsy decision was specified. Results: 392 surveys were mailed; 299 surveys were returned (76.3%) of which 285 (72.7%) were included for data analysis. Average monthly biopsy number was 4.2 lesions per GP. Referral rates ranged from 30% to 87% – plastic and general surgery were the most common referral pathways. Ten GPs did half of all biopsies and their techniques demonstrated a range of consistency with guidelines. Overall, a significantly high range of non‐guideline biopsy techniques was demonstrated including shave, punch biopsy and full excision with flap. Most biopsies (57%) were according to NH and MRC guidelines. Conclusion: Concern exists for the high prevalence of non‐guideline biopsy techniques used in general practice in which melanocytic diagnoses could be missed. Recommendations include a review of guideline knowledge and education, and targeted quality improvement of biopsy techniques.