University of Virginia Health System

U.VA. HEALTH SYSTEM RESEARCHER DEVELOPS NEW PROTOCOL FOR DETECTING SKIN CANCERS

Concerns about developing skin cancer are one of the top 25 reasons that people visit their primary care doctor's office. But biopsies done on 80 percent of the skin lesions that are seen in a primary care population come up negative for skin cancer. To provide a better way for primary care physicians to diagnose skin cancer, a physician researcher at the University of Virginia Health System has completed an evidence-based review on the subject. The comprehensive literature review will appear in the March 5 edition of the Journal of Family Practice.

"Until now, no one had ever developed a protocol that incorporates all of the evidence that can be used to diagnose skin malignancies," said Dr. Scott Strayer, physician at U.Va. Health System and author of the review. "We put it into a one-page, step by step approach for evaluating any skin lesion."

The compiled literature is made up of peer-reviewed research. Literature that was not peer-reviewed or evidence-based was rejected. Evidence-based refers to the concept of doctors making medical decisions using outcomes-based research literature. Strayer made sure that the research trials he used were randomized-control trials or systematic reviews. This project began in the fall of 2001 and covers diagnosis strategies for the following types of skin lesions and cancers:

• Skin Neoplasms
  
  
• Melanoma
  
  
• Squamous Cell Carcinoma
  
  
• Basal Cell Carcinoma

The recommendations for physicians include the "ABCDE Criteria" and the British "Revised 7-Point Checklist" in determining whether or not to do a biopsy on a skin lesion. The "ABCDE Criteria" were developed by the American Cancer Society as a clinical test for ruling out malignant melanomas. The "Revised 7-Point Checklist" also helps to rule out malignant melanomas. But Strayer cautions that there are still some cases that will be missed using these criteria.

"Ultimately if the patient is still worried about it, if the physician is still worried about it, go ahead and biopsy it. A physician should never send a patient out the door because they don't meet all the criteria. But at the same time, everyone who comes through the door doesn't have to have a biopsy. Here the physician is called upon to use their judgment based on the evidence," he said.

According to Strayer, this evidence-based approach to diagnosing skin cancer could set the standard for how primary care physicians approach skin lesions.

March 5, 2003