Choosing to biopsy or refer suspicious melanocytic lesions in general practice

BMC Family Practice

Research Article

Marjan Kljakovic¹  Sean Robison²  Peter Barry³ 

[1] FRACGP, PhD, Professor of General Practice, Academic Unit of General Practice and Community Health, Australian National University Medical School, 0200, Canberra, ACT, Australia;MBBS (Hons), Medical School, Australian National University, 0200, Canberra, ACT, Australia;MBBS, FRACS, Surgical Oncologist, Canberra Melanoma Unit, Calvary Clinic, 2617, Canberra, ACT, Australia;

关键词: Biopsy;    General practice;    Guidelines;    Melanoma;    Audit;   

DOI  :  10.1186/1471-2296-13-78

 received in 2012-03-21, accepted in 2012-07-24,  发布年份 2012

来源: Springer

【 摘 要 】

BackgroundGeneral practitioners (GPs) are involved in the management of most melanocytic skin lesions in Australia. A high quality biopsy technique is a crucial first step in management, as it is recognized that poor techniques can mislead, delay, or miss a diagnosis of melanoma. There has been little published on the biopsy decisions and techniques of GPs. This study aims to describe the current management choices made by GPs for suspicious melanocytic skin lesions and to compare their choices with the best practice guidelines.MethodsAn anonymous survey of GPs presented with three clinical scenarios with increasing complexity of melanoma in which a referral or biopsy decision was specified.Results391 mailed surveys with a 76.3% response rate. Mean biopsy experience was 4.14 biopsies per GP per month. The rates of choosing to refer among the three scenarios were 31%, 52% and 81% respectively, with referral to surgery being the most common choice (81%). Most biopsy techniques (55%) were chosen according to best practice guidelines, although non-guideline biopsy techniques chosen included shave (n = 10), punch biopsy (n = 57), wide excisions (n = 65), and flaps (n = 10). The few GPs (n = 5) who identified themselves as skin specialist GPs were no more likely to adhere to guidelines than their colleagues.ConclusionA majority of referrals and biopsies were chosen by GPs according to best practice guidelines, but concern remains for the high proportion of GPs making non-guideline based choices. How GPs choose to biopsy or refer needs further training, audit, and research if Australia is to improve the outcome of melanoma management in general practice.

【 授权许可】

CC BY   
© Robison et al.; licensee BioMed Central Ltd. 2012