Nevus doctor - Clinical decision support for skin cancer in primary health care
In fair-skinned populations the skin is the organ with the highest cancer rate. During the last decades there has been a substantial increase in the incidence of skin cancer. Early detection and treatment prevent morbidity, but can be challenging since malignant tumours are easily confused with benign skin lesions. For primary care physicians early detection is even more challenging, since they cannot obtain the same high level of training and experience compared to dermatologists. Referring the patient is not always possible because of few available dermatologists and long waiting lists. Therefore, to be sure not to overlook skin cancer, a fairly high number of skin lesions are biopsied by primary care physicians to exclude malignancy.
Use of dermoscopy has improved skin cancer diagnosis in specialist health care. Efforts to introduce this diagnostic technique to primary health care have not succeeded. A computer-based clinical decision support system may analyse dermoscopic skin images and provide the primary care doctor with additional information that is otherwise only accessible to the specialist. As a consequence skin patients may avoid unnecessary referrals and biopsies.
The aims of the new decision support system are:
- Earlier detection of skin cancer (melanoma and NMSC).
- Better selection of suspicious lesions prior to biopsy in order to avoid unnecessary biopsies.
The objective of this study is to test the computer-based clinical decision support system "Nevus doctor". In a randomised controlled trial primary care physicians are assigned to an intervention or control group. Only doctors randomised to the intervention group will have access to Nevus doctor. The programme will support the doctors in deciding if a skin lesion needs further investigation through biopsy or referral to a specialist. The primary outcome is diagnostic accuracy regarding the detection of skin lesions suggestive of melanoma skin cancer.