Journal Information
Vol. 98. Issue 3.
Pages 171-177 (April 2007)
Vol. 98. Issue 3.
Pages 171-177 (April 2007)
Original article
DOI: 10.1016/S1578-2190(07)70421-3
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Minor cutaneous ambulatory surgery and cryotherapy. Comparative study between a dermatologist and family physicians
Cirugía Menor Ambulatoria Dermatológica y Crioterapia. Estudio Comparativo Entre un Dermatólogo y Médicos de Familia
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J. Graellsa,??
Corresponding author
26449jge@comb.es

Correspondence: Salvat Papasseit 58-62, 2-1, 08830 Sant Boi de Llobregat, Barcelona, Spain.
, A. Espinolab, C. Barriob, M.D. Muñozb, A. Románb, N. Parelladab
a Servicio de Dermatología, Hospital Comarcal de Sant Boi de Llobregat, Barcelona, Spain
b Médico de Familia, Asistencia Primaria, Districte Baix Llobregat Litoral, Barcelona, Spain
Article information
Abstract
Introduction

Lack of diagnostic skill in cutaneous surgery may lead to erroneous and potentially detrimental therapies. This study compares the diagnosis and treatment in cutaneous surgery, including cryotherapy, between a dermatologist and family physicians.

Methods

It is an observational, prospective study on a random sample of patients that consulted the dermatologist for candidate lesions. Each lesion was independently evaluated by a dermatologist and a family physician, both of whom assigned the clinical diagnosis and therapeutic advice. Concordance for diagnosis, recommended treatment and indication for cryotherapy was calculated by Cohen's kappa coefficient.

Results

Six hundred forty-six lesions were evaluated. Global kappa indexes were 0.69 (95% CI, 0.65-0.73) for diagnostic concordance, 0.62 (95% CI, 0.56-0.67) for recommended treatment and 0.73 (95% CI, 0.67-0.78) for indication of cryotherapy. Diagnostic concordance was significantly better for melanocytic nevus, achrocordon and for lesions with multiple and monomorphous presentation, and worse for isolated pigmented lesions. For recommended treatment concordance was better for multiple and monomorphous lesions and worse for skin cancer and seborrheic keratosis. For indication of cryotherapy concordance was worse for skin cancer, melanocytic nevus, acrochordon and seborrheic keratosis. Family physicians made an erroneous indication for cryotherapy in 5.88% of cases, including 3 non melanoma skin cancers.

Conclusions

Concordance between dermatologists and family physicians for minor cutaneous surgery is generally good. Family physicians should be more careful in evaluating solitary pigmented lesions and patients at risk for skin cancer.

Key words:
clinical competence
family physicians
Primary Care
minor surgery
cryotherapy
Resumen
Introducción

En cirugía dermatológica, una menor habilidad diagnóstica podría conducir a tratamientos erróneos y potencialmente perjudiciales. En este trabajo se compara el diagnóstico y la decisión terapéutica en cirugía dermatológica, incluyendo la crioterapia, entre un dermatólogo y médicos de familia.

Métodos

Estudio prospectivo observacional, sobre una muestra no seleccionada de pacientes que consultan al dermatólogo por lesiones candidatas. Cada lesión fue evaluada independientemente por un dermatólogo y un médico de familia, consignando ambos el diagnóstico clínico y el consejo terapéutico. Se calculó la concordancia para el diagnóstico, tratamiento recomendado e indicación de crioterapia mediante el estadístico kappa de Cohen.

Resultados

Se evaluaron 646 lesiones. Los índices kappa globales fueron 0,69 (intervalo de confianza [IC] del 95%, 0,65-0,73) en concordancia diagnóstica, 0,62 (IC del 95%, 0,56-0,67) en tratamiento recomendado y 0,73 (IC del 95%, 0,67-0,78) en indicación de crioterapia. La concordancia diagnóstica resultó significativamente mejor en nevus melanocítico, acrocordón y en lesiones con presentación múltiple y monomorfa, y peor en lesiones pigmentadas aisladas. En tratamiento recomendado fue mejor para lesiones múltiples y monomorfas, y peor en cáncer de piel y queratosis seborreica. En indicación de crioterapia fue peor en cáncer de piel, nevus melanocítico, acrocordón y queratosis seborreica. Los médicos de familia indicaron crioterapia incorrectamente en el 5,88% de casos, incluyendo tres cánceres de piel no melanoma.

Conclusiones

La concordancia entre dermatólogos y médicos de familia en cirugía menor dermatológica es en general buena. Los médicos de familia deberían ser cautos en lesiones pigmentadas solitarias y pacientes de riesgo para cáncer de piel.

Palabras clave:
competencia clínica
médicos de familia
Atención Primaria
cirugía menor
crioterapia
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References
[1.]
D.W. Wall.
A review of minor surgery in general practice in the United Kingdom.
Fam Practice, 4 (1987), pp. 322-329
[2.]
J.M. Arribas Blanco, M.E. Gil Sanz, C. Sanz Rodrigo, I. Morón Merchante, S. Muñoz-Quirós Aliaga, A. López Romero, et al.
Efectividad de la cirugía menor dermatológica en la consulta del médico de familia y satisfacción del paciente en relación con la cirugía ambulatoria.
Med Clin (Barc), 107 (1996), pp. 772-775
[3.]
P.J. Tárraga López, E. Marín Nieto, D. García Olmo, A. Celada Rodríguez, J. Solera Albero, M. Cerdán Oliver, et al.
Impacto económico de la implantación de un programa de cirugía menor en atención primaria.
Aten Primaria, 27 (2001), pp. 335-338
[4.]
R.A. Clark, R.L. Rietschel.
The cost of initiating appropriate therapy for skin diseases: A comparison of dermatologists and family physicians.
J Am Acad Dermatol, 9 (1983), pp. 787-796
[5.]
B.R. Weinstein, J.D. Bernhard, T.H. Winters.
Is it appropriate for primary care physicians to perform skin biopsies?.
Arch Intern Med, 146 (1986), pp. 1293-1294
[6.]
B.R. Cassileth, W.H. Clark, E.J. Lusk, B.E. Frederick, C.J. Thompson, W.P. Walsh.
How well do physicians recognize melanoma and other problem lesions?.
J Am Acad Dermatol, 14 (1986), pp. 555-560
[7.]
D.L. Ramsay, P.E. Weary.
Primary care in dermatology: Whose role should it be?.
J Am Acad Dermatol, 35 (1996), pp. 1005-1008
[8.]
B.G. Gerbert, T. Maurer, T. Berger, S. Pantilat, S.J. McPhee, M. Wolff, et al.
Primary care physicians as gatekeepers in managed care.
Arch Dermatol, 132 (1996), pp. 1030-1038
[9.]
J.D. Whited, R.P. Hall, D.L. Simel, R.D. Horner.
Primary care clinicians’ performance for detecting actinic keratoses and skin cancer.
Arch Intern Med, 157 (1997), pp. 985-990
[10.]
A. Morrison, S. O’Loughlin, F.C. Powell.
Suspected skin malignancy: a comparison of diagnoses of family practitioners and dermatologists in 493 patients.
Int J Dermatol, 40 (2001), pp. 104-107
[11.]
F. Camacho.
Pacientes y médicos satisfechos.
Med Clin (Barc), 109 (1997), pp. 476-477
[12.]
D.L. Ramsay, A.B. Fox.
The ability of primary care physicians to recognize the common dermatoses.
Arch Dermatol, 117 (1981), pp. 620-622
[13.]
R.F. Wagner, D. Wagner, J.M. Tomich, K.D. Wagner, D.J. Grande.
Resident's corner: diagnoses of skin disease: dermatologists vs. nondermatologists.
J Dermatol Surg Oncol, 11 (1985), pp. 476-479
[14.]
R.S. Stern, C. Boudreaux, K.A. Arndt.
Diagnostic accuracy and appropriateness of care for seborrheic keratoses. A pilot study of an approach to quality assurance for cutaneous surgery.
JAMA, 265 (1991), pp. 74-77
[15.]
D. Federman, D. Hogan, J.R. Taylor, P. Caralis, R.S. Kirsner.
A comparison of diagnosis, evaluation, and treatment of patients with dermatologic disorders.
J Am Acad Dermatol, 32 (1995), pp. 726-729
[16.]
R.S. Kirsner, D.G. Federman.
Lack of correlation between internist’ ability in dermatology and their patterns of treating patients with skin disease.
Arch Dermatol, 132 (1996), pp. 1043-1046
[17.]
M.J. Guereña, C. Perna, J. Gajate.
Correlación clinicopatológica de 370 casos de cirugía menor dermatológica realizada por médicos de familia.
Aten Primaria, 28 (2001), pp. 320-325
[18.]
J.R. Landis, G.G. Koch.
The measurement of observer agreement for categorical data.
Biometrics, 33 (1977), pp. 159-174
[19.]
J.E. Hocutt.
Skin cryosurgery for the family physician.
Am Fam Phys, 48 (1993), pp. 445-452
[20.]
D.M. Jester.
Cryotherapy of dermal abnormalities.
Prim Care, 24 (1997), pp. 269-280
[21.]
J. Pérez Sánchez, J. Villar Gil.
Crioterapia en Atención Primaria.
Medifam, 8 (1998), pp. 418-426
[22.]
R.C. Mendenhall, D.L. Ramsay, R.A. Girard, G.P. DeFlorio, P.E. Weary, J.S. Lloyd.
A study of the practice of dermatology in the United States.
Arch Dermatol, 114 (1978), pp. 1456-1462
[23.]
A. Ortiz, T. Herrera, C. Pérez del Molino, F. Piñeiro, M.L. Perales, P. Muñoz.
Epidemiología de las enfermedades dermatológicas en Atención Primaria.
Rev San Hig Pub, 66 (1992), pp. 71-82
[24.]
A. Green, D. Leslie, D. Weedon.
Diagnosis of skin cancer in the general population: clinical accuracy in the Nambour survey.
Med J Aust, 148 (1988), pp. 447-450
[25.]
S. Barrow, A.D. Fisher, D.M. Seex, M.S. Abdul.
General practitioner attitudes to day surgery.
J Publ Health Med, 16 (1994), pp. 318-320
Copyright © 2007. Academia Española de Dermatología y Venereología and Elsevier España, S.L.
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