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Raise threshold for melanoma referral, say researchers

The sensitivity of melanoma diagnosis in primary care could be improved by hiking the threshold for intervention needed under NICE’s recommended score, say researchers.

The study – the first to evaluate the score in primary care - showed that the accuracy of melanoma diagnosis could be improved by raising the cut off for referral under the seven point checklist cut-off score from three to four.

The research, which was presented at the Society for Academic Primary Care’s conference in Glasgow last week, showed that revising the cut-off score could increase the ability of GPs to reassure patients with benign lesions and correctly refer those with suspicious lesions.

The study examined 1,436 melanoma lesions in 1,182 participants from 15 general practices, and calculated scores blinded to whether they were malignant or benign.

They found the seven point checklist, which takes into account characteristics such as change in lesion size, an irregular border and inflammation, performed moderately well in the identification of clinically significant lesions for primary care. But diagnostic accuracy improved when the cut-off score was revised from three to four.

Lead author Dr Fiona Walter, a GP in Royston, Hertfordshire, and clinical lecturer in general practice at the University of Cambridge, said raising the cut off would improve diagnosis and reduce costs.

She told Pulse: ‘This would result in a diagnostic aid which maintains a very high sensitivity for melanoma while improving the positive predictive value and specificity for clinically significant lesions in primary care, in order not to significantly increase referrals to secondary care’.


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