Diagnostic accuracy of family physicians in identifying high-risk dermatologic conditions requiring emergency referral: a systematic review
DOI:
https://doi.org/10.65759/1e4ykg29Keywords:
Diagnostic accuracy, dermatologic emergencies, family physicians, general practice, melanomaAbstract
Background: Family physicians evaluate skin disorders associated with diagnostic delay, systemic deterioration, tissue destruction, or delayed cancer treatment. These presentations include suspected malignancy, severe drug reactions, and invasive infection, although their referral pathways differ, this review evaluated diagnostic and referral performance in these categories. Methods: Original studies published through 31 Jan 2026 were reviewed using predefined criteria. Patient-based investigations were separated from studies using standardized photographs or clinical vignettes, while cancer pathways were analyzed independently from same-day dermatologic emergencies. Results: Ten studies evaluated diagnostic classification, referral, excision decisions, or image-based recognition. Melanoma sensitivity in general practitioners was 29% in one comparative study, whereas another reported 66.7% sensitivity and 92.0% specificity for recognizing malignant lesions. Following training, dermoscopy increased referral sensitivity from 54.1% to 79.2% without reducing specificity. Sequential dermoscopy reduced excision or referral of suspicious lesions by 56.4%, whereas other diagnostic aids produced inconsistent effects. In an urgent-disease vignette study, family physicians recognized Stevens-Johnson syndrome in 71.4% and pemphigus vulgaris in 28.6% of responses. Conclusion: Diagnostic performance varied according to disease spectrum, clinical setting, physician experience, assessment method, and outcome definition. Training-supported dermoscopy improved selected cancer-triage outcomes, although benefits were not reproduced across all diagnostic technologies.
References
1. Schofield JK, Fleming D, Grindlay D, Williams HC. Skin conditions are the commonest new reason people present to general practitioners in England and Wales. Br J Dermatol. 2011;165(5):1044-1050. doi:[10.1111/j.1365-2133.2011.10464.x].
2. Creamer D, Walsh SA, Dziewulski P, et al. U.K. guidelines for the management of Stevens-Johnson syndrome/toxic epidermal necrolysis in adults 2016. Br J Dermatol. 2016;174(6):1194-1227. doi:[10.1111/bjd.14530].
3. Stevens DL, Bisno AL, Chambers HF, et al. Practice guidelines for the diagnosis and management of skin and soft tissue infections: 2014 update by the Infectious Diseases Society of America. Clin Infect Dis. 2014;59(2):e10-e52. doi:[10.1093/cid/ciu296].
4. Gershenwald JE, Scolyer RA, Hess KR, et al. Melanoma staging: evidence-based changes in the American Joint Committee on Cancer eighth edition cancer staging manual. CA Cancer J Clin. 2017;67(6):472-492. doi:[10.3322/caac.21409].
5. Chen SC, Bravata DM, Weil E, Olkin I. A comparison of dermatologists’ and primary care physicians’ accuracy in diagnosing melanoma: a systematic review. Arch Dermatol. 2001;137(12):1627-1634. doi:[10.1001/archderm.137.12.1627](https://doi.org/10.1001/archderm.137.12.1627).
6. Dinnes J, Deeks JJ, Grainge MJ, et al. Visual inspection for diagnosing cutaneous melanoma in adults. Cochrane Database Syst Rev. 2018;12:CD013194. doi:[10.1002/14651858.CD013194].
7. Jones OT, Jurascheck LC, van Melle MA, et al. Dermoscopy for melanoma detection and triage in primary care: a systematic review. BMJ Open. 2019;9(8):e027529. doi:[10.1136/bmjopen-2018-027529].
8. Youl PH, Baade PD, Janda M, Del Mar CB, Whiteman DC, Aitken JF. Diagnosing skin cancer in primary care: how do mainstream general practitioners compare with primary care skin cancer clinic doctors? Med J Aust. 2007;187(4):215-220. doi:[10.5694/j.1326-5377.2007.tb01202.x].
9. Pockney P, Primrose J, George S, et al. Recognition of skin malignancy by general practitioners: observational study using data from a population-based randomized controlled trial. Br J Cancer. 2009;100(1):24-27. doi:[10.1038/sj.bjc.6604810].
10. Argenziano G, Puig S, Zalaudek I, et al. Dermoscopy improves accuracy of primary care physicians to triage lesions suggestive of skin cancer. J Clin Oncol. 2006;24(12):1877-1882. doi:[10.1200/JCO.2005.05.0864].
11. Menzies SW, Emery J, Staples M, et al. Impact of dermoscopy and short-term sequential digital dermoscopy imaging for the management of pigmented lesions in primary care: a sequential intervention trial. Br J Dermatol. 2009;161(6):1270-1277. doi:[10.1111/j.1365-2133.2009.09374.x].
12. Rosendahl C, Williams G, Eley D, et al. The impact of subspecialization and dermatoscopy use on accuracy of melanoma diagnosis among primary care doctors in Australia. J Am Acad Dermatol. 2012;67(5):846-852. doi:[10.1016/j.jaad.2011.12.030].
13. Walter FM, Morris HC, Humphrys E, et al. Effect of adding a diagnostic aid to best practice to manage suspicious pigmented lesions in primary care: randomized controlled trial. BMJ. 2012;345:e4110. doi:[10.1136/bmj.e4110].
14. Koelink CJL, Vermeulen KM, Kollen BJ, et al. Diagnostic accuracy and cost-effectiveness of dermoscopy in primary care: a cluster randomized clinical trial. J Eur Acad Dermatol Venereol. 2014;28(11):1442-1449. doi:[10.1111/jdv.12306].
15. English DR, Burton RC, del Mar CB, Donovan RJ, Ireland PD, Emery G. Evaluation of aid to diagnosis of pigmented skin lesions in general practice: controlled trial randomized by practice. BMJ. 2003;327(7411):375. doi:[10.1136/bmj.327.7411.375].
16. Westerhoff K, McCarthy WH, Menzies SW. Increase in the sensitivity for melanoma diagnosis by primary care physicians using skin surface microscopy. Br J Dermatol. 2000;143(5):1016-1020. doi:[10.1046/j.1365-2133.2000.03836.x].
17. Aljohani AG, Abduljabbar MH, Hariri J, et al. Assessing the ability of non-dermatology physicians to recognize urgent skin diseases. Cureus. 2023;15(4):e37823. doi:[10.7759/cureus.37823].
18. Chen JY, Fernandez K, Fadadu RP, et al. Skin cancer diagnosis by lesion, physician, and examination type: a systematic review and meta-analysis. JAMA Dermatol. 2025;161(2):135-146. doi:[10.1001/jamadermatol.2024.4382].
19. Page MJ, McKenzie JE, Bossuyt PM, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ. 2021;372:n71. doi:[10.1136/bmj.n71].
20. McInnes MDF, Moher D, Thombs BD, et al. Preferred Reporting Items for a Systematic Review and Meta-analysis of Diagnostic Test Accuracy Studies: the PRISMA-DTA statement. JAMA. 2018;319(4):388-396. doi:[10.1001/jama.2017.19163].
21. Whiting PF, Rutjes AWS, Westwood ME, et al. QUADAS-2: a revised tool for the quality assessment of diagnostic accuracy studies. Ann Intern Med. 2011;155(8):529-536. doi:[10.7326/0003-4819-155-8-201110180-00009].
22. Bossuyt PM, Reitsma JB, Bruns DE, et al. STARD 2015: an updated list of essential items for reporting diagnostic accuracy studies. BMJ. 2015;351:h5527. doi:[10.1136/bmj.h5527].
