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Most Australian GPs followed best practices for assessing possible melanomas
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Most general practitioners in Australia reported best practice guidelines for referrals and biopsies regarding suspicious melanocytic skin lesions, yet more training is required, according to study results.
Two hundred eighty-five general practitioners (GP) answered an anonymous mailed survey (76.3% response) describing three clinical scenarios of possible melanomas of increasing complexity and a choice to refer or conduct biopsy. Australian National Health and Medical Research Council melanoma guidelines were used.
Each GP reported performing a mean of 4.14 biopsies per month. For each scenario, GPs chose to refer 31%, 52% and 81%, respectively; with surgical referral the most common response (81%). Fifty-four percent of GPs chose to refer for a specialist’s opinion where appropriate, the safest option suggested by best practice guidelines. Most referrals were to general surgeons, plastic surgeons and dermatologists. Seventeen percent chose to refer to other GPs, particularly if the GP who performed biopsies worked within the referring GP’s practice.
Fifty-five percent of the biopsy techniques followed best practice guidelines, while non-guideline techniques included shave (n=10), punch biopsy (n=57), wide excisions (n=65) and flaps (n=10). Five respondents identified themselves as skin specialist GPs and were no more likely than others who were surveyed to adhere to recommended guidelines.
The study was limited by having only three scenario selections, and analysis of how GPs would perform was set in a theoretical context rather than actual clinical behavior, the researchers said.
“Concern remains for the high proportion of GPs making non-guideline-based choices,” the researchers said, noting that melanoma is the most common cancer among persons aged 30 to 51 years in Australia and accounts for 3.9% of its cancer deaths. “Further training, audit and research on how GPs choose to biopsy or refer needs to be considered if Australia is to improve melanoma management in general practice.”
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