Some Skin Cancers Missed by Primary Doctors

May. 18, 2011 - General practice health care providers keep an eye out for skin cancer, but they often miss cancer that’s found later by a dermatologist, a new study says.

General practitioners do refer patients to a dermatologist for suspicious skin lesions – but those lesions most often turn out to be benign. Moreover, the dermatologist then frequently finds another skin lesion that’s cancer.

Researchers at Yale University looked at the medical records of 400 people who had been referred to a dermatologist for a suspicious skin area. They wanted to measure the proportion of cancerous lesions first identified by non-dermatologists against those found by dermatologists.

Big difference

The researchers found that only 22 percent of the lesions first noticed by a primary doctor were confirmed as cancerous. But 55 percent of lesions found by a dermatologist during the referral visit were cancerous. And 10 percent of those lesions were melanoma, the most serious form of skin cancer.

Why such a wide discrepancy in outcomes?

"It is possible that with the multitude of tasks needing to be performed in primary care, full-body skin examinations may be omitted or not stressed," says study author Daniel G. Federman, M.D.

Common cancer

Skin cancer is the most common cancer in the U.S. More than 3.5 million cases are diagnosed each year, according to the Skin Cancer Foundation (SCF).

Darrell S. Rigel, M.D., at the SCF, says the study results are consistent with what he and most other dermatologists see – that many skin cancers are found only after a primary doctor has already screened the person.

"This is not to disrespect any non-dermatologists," Dr. Rigel says. “The reality is, we're just experts at it because we do it every day.”

Skin cancers can occur anywhere on the body. Basal cell and squamous cell cancers are most often are found on areas exposed to the sun.

The most common symptom is a new growth on the skin or a sore that does not heal in the usual time.

The first sign of a melanoma is frequently a change in the shape, color, or size of an existing mole, or the appearance of a new mole in adults.

It’s important to look for changes in existing moles and new moles. You can remember what type of changes to look for in an existing mole by remembering the ABCD rule:

• Asymmetry. The shape of one half of the mole is different from the other half

• Borders. The outside edges of the mole are ragged

• Color. The mole has different shades of colors, such as brown, black, tan, red, or blue (although some can be white or have no color change)

• Diameter. The size of the mole has changed

If you notice any of these changes in a mole or the growth of a new mole, or a mole begins to bleed or ooze fluid, see your health care provider. Skin cancer is diagnosed by a biopsy.

Always talk with your health care provider to find out more information.