Dermoscopy for Melanoma Screening in Primary Care: Impact on Referral Rates

Abstract

Introduction: Dermoscopy improves melanoma diagnostic accuracy but may increase unnecessary referrals. Its effect in primary care (non-dermatologist) settings is uncertain. Methods: Systematic review of 11 studies (n=38,204 pigmented lesions) comparing primary care physicians (PCPs) using dermoscopy versus naked eye. Reference standard: histopathology or expert panel. Outcomes: sensitivity/specificity for melanoma, benign-to-malignant biopsy ratio, referral rate to dermatology. Results: Dermoscopy increased sensitivity (PCP 72% vs 54%, p=0.002) and specificity (87% vs 78%, p=0.003). Benign-to-malignant biopsy ratio improved from 18:1 to 11:1 (p=0.01). Referral rate to dermatology increased from 8% to 14% (p=0.01), but appropriate referrals (melanoma detected) doubled. PCPs required median 6 hours training to achieve these results. Discussion: Dermoscopy improves PCP accuracy but increases referrals. The net effect is earlier melanoma diagnosis with acceptable additional workload. Conclusion: Primary care dermoscopy with structured training improves melanoma detection and appropriate referrals despite higher overall referral rates.