Diagnostic accuracy of family physicians in identifying high-risk dermatologic conditions requiring emergency referral: a systematic review

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.