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Open Access Research article

Choosing to biopsy or refer suspicious melanocytic lesions in general practice

Sean Robison1*, Marjan Kljakovic2 and Peter Barry3

Author affiliations

1 MBBS (Hons), Medical School, Australian National University, Canberra, 0200, ACT, Australia

2 FRACGP, PhD, Professor of General Practice, Academic Unit of General Practice and Community Health, Australian National University Medical School, Canberra, 0200, ACT, Australia

3 MBBS, FRACS, Surgical Oncologist, Canberra Melanoma Unit, Calvary Clinic, Canberra, 2617, ACT, Australia

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Citation and License

BMC Family Practice 2012, 13:78  doi:10.1186/1471-2296-13-78

Published: 8 August 2012

Abstract

Background

General 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.

Methods

An anonymous survey of GPs presented with three clinical scenarios with increasing complexity of melanoma in which a referral or biopsy decision was specified.

Results

391 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.

Conclusion

A 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.

Keywords:
Biopsy; General practice; Guidelines; Melanoma; Audit