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Warning not to curb skin Ca referral

By Emma Wilkinson

GPs should resist pressure to curb their referrals for suspected skin cancer and hold a high index of suspicion when examining moles, researchers advise.

A new study concludes it is impossible to distinguish atypical benign moles from early melanomas, and that it is better to risk over-referral than to miss malignancies.

The research found a number of characteristics were predictive of melanoma, but that only two helped distinguish lesions with mild to moderate histological dysplasia from benign atypical moles. In lesions with mild dysplasia, age increased risk of malignancy by 5 per cent per year, while presence of black or blue-black doubled risk.

But the researchers said this was insufficient to distinguish the two groups reliably. They concluded that clinicians must be willing to excise a 'considerable number' of benign pigmented lesions to avoid missing malignancies.

Study leader Professor Julia Newton-Bishop, professor of dermatology in the genetic epidemiology division at St James's University Hospital, Leeds, said: 'We were trying to see how we could increase the accuracy. But we showed it's not possible to distinguish early melanoma from moles that are slightly atypical.'

Professor Newton-Bishop said GPs should refer if patients had established risk factors (see box). 'GPs do sometimes worry about over-referring. But the development of melanoma is a slow process and in the early stages it looks quite innocuous.'

Dr Russell Thorpe, cancer lead for Flyde PCT and a GP in St Anne's, Lancashire, said the findings were worrying as GPs were often criticised for referring too many patients.

'This study would certainly help our discussions with dermatology. It shows it's very difficult to pick up early melanoma.

'Because it's such a horrendous condition, it's beholden on us to increase capacity rather than arguing about referrals.'

Dr Nick Brown, a GP in Chippenham and cancer lead for Kennet and North Wilts PCT, said: 'We are always being hounded to reduce referrals and this is something that goes against that.'

The research, presented this month at the American Academy of Dermatology annual conference in San Francisco, reviewed 475 pigmented lesions removed in a large teaching hospital over a five-year period.

Referral to pigmented lesion clinic

· Bigger than 5mm in diameter

· Irregular edge

· Irregular colour

· Particular suspicion in older people, men, or if the mole is new or changing

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