Dermatoscopy in general practice.

Background of the study:

GP's are regulary asked to analyse a pigmented lesion or local swelling (nodule) of the skin. It is expected that in the future there will be a increase of skincancer patients in The Netherlands and in other European countries because of increasing incidence and the aging of the population. In secundary care the dermatoscope offers an increase in specificity (15%) and sensitivity (25%) to the diagnostic proces and also gives a decrease of small surgery. We expect the dermatoscope to give an increase of diagnostic accuracy in the GP's office.



Objective of the study:

The primary aim of the study is the validation of the dermatoscope as a diagnostic aid for analyzing patients who visit the GP with the suspicion of a skin malignancy. Secundary aim of the study is the determination of the extent of health care consumption: the number of referrals to secundary care, the number of excisions send to the pathologist, both compared to the golden standard (clinical judgement of the dermatologist or the histological diagnosis). In a economical evaluation the costs of both diagnostic strategies will be investigated.



Study design:

The design of this study is a diagnostic trial. In which the GP's will be randomized in stead of patients.



Study population:

The source populations consists of patients aged 18 years or older, who visit the GP because of a skin lesion for which they have not consulted their GP before. Also the GP is uncertain of a benign diagnosis.



Intervention:

In the intervention group the dermatoscope will be used after clinical analysis to analyse the skinlesion and to diagnose this lesion. In the control group the diagnostic fase will be finished after the clinical analysis without the use of a dermatoscope.



Outcome:

The primary outcome measure is the diagnostic accuracy of the dermatoscope as a diagnostic test analyzing skinmalignancies in general practice. Secondary outcome measures are the sensitivity, specificity, the number of excisions c.q. biopsies and referrals to secundary care. In a economical evaluation the costs of the two diagnostic strategies will be analysed.

We expect the dermatoscope to give an increase in diagnostic accuracy in general practice.

Patients will be included for 1 year.

In the interventrion group the dermatoscope will be used after normal clinical evaluation in order to diagnose and evaluate the lesion. In the controlgroup the evaluation of the skin lesion ends after normal clinical evaluation, without the use of the dermatoscope.