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Background: Primary care physicians (PCPs) are often expected to screen for melanomas and refer patients with suspicious pigmented lesions to dermatologists., Objective: To assess whether there is a difference between dermatologists and PCPs in accurately diagnosing melanoma and appropriately managing (based on decisions to refer/biopsy) suspicious pigmented lesions., Design, Participants: A survey based on a random sample of 30 photographs of pigmented lesions with known pathology was administered to 101 dermatologists and 115 PCPs from October 2001 to January 2003., Measurements: Likelihoods that a photographed lesion was melanoma and that the lesion should be biopsied/referred were scored on a 1 to 10 scale. Accuracy of melanoma diagnosis and appropriateness of pigmented lesion management were compared between dermatologists and PCPs by using the areas under (AUC) the receiver operating characteristic (ROC) curves., Results: Dermatologists were superior to PCPs in diagnosing melanomas (AUC 0.89 vs 0.80, P<.001) and appropriately managing pigmented lesions (AUC .84 vs 0.76, P<.001). PCPs who tended to biopsy lesions themselves did better at managing pigmented lesions than PCPs who did not perform biopsies. Dermatology training during residency did not significantly improve the diagnostic accuracy of PCPs nor their management of pigmented lesions., Conclusions: Dermatologists have both better diagnostic accuracy and ability to manage pigmented lesions than PCPs. Yet, there is a shortage of dermatologists to meet the demand of accurate melanoma screening. More innovative strategies are needed to better train PCPs and enhance skin cancer screening.

In order to understand the burden of skin disease on patient populations, researchers need to be able to measure exposures and outcomes of interest in a population-based study. One method of obtaining such information is mailed patient surveys. This method of obtaining information, however, raises concerns regarding possible low response rates, and to the best of our knowledge, this method has not been attempted in large dermatology patient populations with a high response rate. We sought to determine whether using a slightly modified version of the Dillman Total Design Method as a mailed survey protocol would result in a high response rate in a dermatology population. A mail survey was sent using a slightly modified version of Dillman's Total Design Method to 4894 patients seen in the Dermatology Department of the University of Pennsylvania, who were diagnosed with nonmelanoma skin cancer, dermatophytosis, acne rosacea, seborrheic keratosis, or warts; 74.1% of the subjects responded to the mailings; 69.8% (n=3203) of patients returned a completed survey. Response rates (both as overall response and as survey completers only) were high across a wide spectrum of dermatologic illnesses and did not vary significantly by entry diagnosis. Dillman's Total Design Method appears to be an effective tool for researchers studying the burden of skin disease in a large sample of dermatology patients.

Background: The characteristics and prevalence of dermatologists reading dermatopathology slides are not well understood. Methods: We surveyed 1406 members of the American Academy of Dermatology (AAD), including all 497 who were also members of the American Society of Dermatopathology (ASDP) along with a random sample of the remaining AAD members who were not ASDP members. Seven hundred and thirty of 1406 (51.9%) responded with a usable survey. Logistic regression was used to analyze responses by ASDP member dermatologists, non-ASDP member dermatologists and in a weighted analysis for dermatologists as a whole. Results: A total of 32.7% of dermatologists as a whole generated at least one final microscopic diagnosis in the preceding year. Multivariate analysis demonstrated that men were significantly more likely to read dermatopathology slides (odds ratio (OR) = 1.90; 95% confidence interval (CI) 1.16–3.12; p = 0.01). Additionally, there was significant variation by region (p < 0.001); compared with dermatologists in the Midwest, dermatologists in the Southeast (OR = 0.39; 95% CI 0.19–0.80) were significantly less likely to read slides, while those in the Mountain (OR = 3.09; 95% CI 1.10–8.72) and West (OR = 2.01; 95% CI 1.04–3.90) regions were significantly more likely. There were no significant associations found between reading slides and the year of residency completion, the number of patients seen per week or being primarily in academics. Conclusions: The practice of dermatologists reading dermatopathology slides is relatively common, with significant regional and sex differences. [ABSTRACT FROM AUTHOR]

Background: Primary care physicians (PCPs) are often expected to screen for melanomas and refer patients with suspicious pigmented lesions to dermatologists.Objective: To assess whether there is a difference between dermatologists and PCPs in accurately diagnosing melanoma and appropriately managing (based on decisions to refer/biopsy) suspicious pigmented lesions.Design, Participants: A survey based on a random sample of 30 photographs of pigmented lesions with known pathology was administered to 101 dermatologists and 115 PCPs from October 2001 to January 2003.Measurements: Likelihoods that a photographed lesion was melanoma and that the lesion should be biopsied/referred were scored on a 1 to 10 scale. Accuracy of melanoma diagnosis and appropriateness of pigmented lesion management were compared between dermatologists and PCPs by using the areas under (AUC) the receiver operating characteristic (ROC) curves.Results: Dermatologists were superior to PCPs in diagnosing melanomas (AUC 0.89 vs 0.80, P<.001) and appropriately managing pigmented lesions (AUC .84 vs 0.76, P<.001). PCPs who tended to biopsy lesions themselves did better at managing pigmented lesions than PCPs who did not perform biopsies. Dermatology training during residency did not significantly improve the diagnostic accuracy of PCPs nor their management of pigmented lesions.Conclusions: Dermatologists have both better diagnostic accuracy and ability to manage pigmented lesions than PCPs. Yet, there is a shortage of dermatologists to meet the demand of accurate melanoma screening. More innovative strategies are needed to better train PCPs and enhance skin cancer screening. [ABSTRACT FROM AUTHOR]

Presents a quiz case for diagnosis in the area of dermatology based on the clinical manifestation of a rapidly growing nodule and dome-shaped yellow papules on the face.

Although a nevus with the microscopic features of a ‘dysplastic nevus’ is commonly seen, the nomenclature used to describe such a lesion has been thought to be inconsistent. A 1992 National Institutes of Health (NIH) Consensus Conference sought to unify nomenclature and suggested that the term ‘nevus with architectural disorder’ be used along with a comment on melanocytic atypia. We performed a cross-sectional mail survey to determine preferred terminology as well as the level of adherence to the NIH-recommended nomenclature. All 856 active members of the American Society of Dermatopathology (ASDP) and 1100 (13.0%) of the 8471 active members of the American Academy of Dermatology (AAD) were surveyed. Five hundred and thirty-three ASDP members and 483 AAD members who fulfilled eligibility criteria completed the questionnaire. The term ‘dysplastic nevus’ was favored by the largest number of responders (favored by 39.1% of ASDP members and 62.3% of AAD members), while the 1992 NIH Consensus Conference-recommended terminology was the second most popular term (25.3% of ASDP and 15.1% of AAD members). Dermatopathologists (OR = 1.9, p = 0.0001) and those who had dual training in dermatology and dermatopathology (OR = 1.6, p = 0.02 for ASDP members; OR = 2.3, p = 0.02 for AAD members) were more likely to adhere to the 1992 NIH Consensus Conference nomenclature. Despite attempts to unify nomenclature for microscopically dysplastic nevi through the NIH Consensus Conference, wide variation in terminology persists. Shapiro M, Chren M-M, Levy RM, Elder DE, LeBoit PE, Mihm Jr MC, Margolis DJ, Gimotty PA, Ming ME. Variability in nomenclature used for nevi with architectural disorder and cytologic atypia (microscopically dysplastic nevi) by dermatologists and dermatopathologists. [ABSTRACT FROM AUTHOR]

Presents various cases related to dermatology. Violaceous plaques in a patient with acquired immunodeficiency syndrome; Multiple bilateral vesiculobullous lesions on the lower extremitis; Multiple facial papules in an adult; Bilateral periorbital eruption in an immunocompromised host.

Presents four skin disease cases. Case of a 50-year-old woman with earlobe dermatitis; Case of a 27-year-old man with painful skin nodules and epididymo-orchitis; Case of a 36-year-old woman with recurrent blisters on the hands and face; Case of a 51-year-old man with erythematous nodulous lesion on the hard palate.

Presents photographs of reported cases of skin diseases. Erythematous annular plaques in a necklace distribution; Papules on the hand; Asymptomatic papules on a child.

Presents pictures and medical cases of skin diseases. Verrucous plaques on the face; Ulcerating verrucous plaque on the foot; Extensive bluish gray skin pigmentation and severe arthropathy; Grouped papules on the arm of an infant.

Presents news concerning skin diseases as of December 1999. Annular plaque on the face; Nodule on the cheek; Linear warty lesions in a child.

Presents various dermatologic cases, compiled as of August 2002. Pea-sized papules and gooseflesh plaques in a woman; Recurrent pustular rash in a pregnant woman; Generalized itchy flexural eruption in a pediatric patient.

Presents various cases of skin diseases. Multiple annular plaques on the face; Dermal nodule on the neck; Severe nail dystrophy associated with painful fingertips; Chronic pustular eruption of the thumbs.

Discusses several skin-related diseases. Tender nodules on the legls of a cardiac transplant recipient; Multiple light-yellow papules; Symmetrical black plaques on the toes; Diffuse and progressive papules and nodules.