Margaret A.WinkerMD, Senior EditorIndividualAuthorPhil B.FontanarosaMD, Senior EditorIndividualAuthor
To the Editor.—Drs Whited and Grichnik1 suggest a referral to a dermatologist for patients who have at least 1 major sign of suspected melanoma based on the United Kingdom 7-point checklist. I am sure many of my fellow family physicians would agree with me that we are capable of performing an appropriate biopsy for a patient with suspected melanoma. Perhaps the authors base this recommendation on their conclusion that "nondermatologists' examinations . . . are less sensitive than those performed by dermatologists."1 Unfortunately, many of the studies they cite compare internal medicine and family practice residents with dermatology residents and attending or practicing dermatologists. As with other skills, diagnosing melanoma requires some practice, and it is unfair to make a comparison involving resident physicians. The more appropriate studies are those that compare practicing family practitioners with practicing dermatologists. In 1 study with this design, New Zealand general practitioners did as well as dermatologists in deciding when to perform a biopsy.2 I wonder if a similar study done in the United States comparing board-certified family physicians with board-certified dermatologists would have similar outcomes. Until such a study is done, should not the recommendation be that any patient with at least 1 major sign be assessed for possible biopsy by an experienced practitioner?
Solomon GL. Clinical Diagnosis of Moles vs Melanoma. JAMA. 1998;280(10):881–882. doi:10-1001/pubs.JAMA-ISSN-0098-7484-280-10-jac80015
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