The visual inspection of a suspicious skin lesion using the naked eye alone is not enough to ensure the accurate diagnosis of skin cancer, a group of experts have concluded following a largescale systematic review of research.
The visual inspection of a suspicious skin lesion using the naked eye alone is not enough to ensure the accurate diagnosis of skin cancer, a group of experts have concluded following a largescale systematic review of research.
Published today in The Cochrane Library, the Special Collection of Cochrane Systematic Reviews brings together a review of a large body of research on the accuracy of tests used to diagnose skin cancer. The suite of eleven reviews was led by Dr Jac Dinnes at the University of Birmingham and supported by the Cochrane Skin Group and a team of over 30 researchers and expert advisors. The work was funded by the National Institute for Health Research (NIHR).
The reviews summarise research evidence assessing the accuracy of different diagnostic tests to support clinical and policy related decision making in the diagnosis of all types of skin cancer.
Dr Jac Dinnes, of the University of Birmingham’s Institute of Applied Health Research, said: “Early and accurate detection of all skin cancer types is essential to manage the disease and to improve survival rates in melanoma, especially given the rate of skin cancer world-wide is rising.
“The visual nature of skin cancer means that it can be detected and treated in many different ways and by a number of different types of specialists, therefore the aim of these reviews is to provide the world’s best evidence for how this endemic type of cancer should be identified and treated.
“We have found that careful consideration should be given of the technologies that could be used to make sure that skin cancers are not missed, at the same time ensuring that inappropriate referrals for specialist assessment and inappropriate excision of benign skin lesions are kept to a minimum.”
There are three main forms of skin cancer. Melanoma and cutaneous squamous cell carcinoma (cSCC), are high-risk skin cancers with the potential to spread and cause death. A basal cell carcinoma (BCC) rarely spreads, usually remaining localised with potential to infiltrate and damage surrounding tissue.
Key findings of the Special Collection were:
Cochrane Skin Group founder Professor Hywel Williams, of the Centre of Evidence-Based Dermatology at the University of Nottingham, said: “Completing this broad suite of detailed reviews was a real marathon.
“Apart from a few exceptions, I was surprised by how poor the overall study designs were, especially in terms of accurately documenting where on the clinical pathway patients were tested.
“Although some useful conclusions have emerged, for example, on the role of dermoscopy, the greatest value of the research is to serve as a yardstick for designing future studies evaluating skin cancer diagnosis techniques on patients who are typically seen in GP and specialist settings.”
The research team said that future studies evaluating diagnostic skin cancer tests should recruit patients with suspicious skin lesions at the point on the clinical pathway where the test under evaluation will be used in practice.
Further research is also needed to evaluate whether checklists to assist diagnosis by visual inspection alone can improve accuracy and to identify how much accuracy varies according to the level of expertise of the clinician carrying out the assessment.
Well-designed studies of dermoscopy in primary care are needed, and the best ways of delivering dermoscopy training need to be identified.
The reviews have been shared with The National Institute for Health and Care Excellence (NICE) to inform a potential update of the NICE Melanoma guideline, which was last updated in 2015.
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