Dermoscopy in General Practice: A Retrospective Study of Skin Lesion Assessment, Diagnostic Yield, and Two-Week-Wait (2WW) Referrals

Introduction: Dermoscopy is a non-invasive diagnostic tool allowing for the visualisation of skin lesions with greater clarity than the naked eye.If widely adopted in primary care, it can potentially enhance the diagnostic yield of suspicious skin lesions by general practitioners (GPs), leading to a more effective 2WW (two-week-wait) referral pathway.Objectives: This study aims to assess the effectiveness of dermoscopy in identifying suspicious skin lesions and its impact on the 2WW pathway with regard to referral outcomes and diagnostic yield within primary care.Method: This was a retrospective observational study within a general practice surgery in Eltham Medical Practice, London, UK.A total of 4,658 patients had their skin lesions assessed by a single GP using a dermoscope within a mole clinic between 1 January 2020 and 31 December 2024.There were 575 2WW referrals, with data collected from EMIS Health.Results: Over 60 months (01/01/2020 to 31/12/2024), 4,658 patients underwent dermoscopic assessment, resulting in 575 (12.3%) 2WW referrals.Within referrals, 275 (47.8%) were diagnosed with cancerous or precancerous lesions: 11 cases (1.9%) of melanoma, 54 cases (9.4%) of squamous cell carcinoma (SCC), and 144 cases (25.0%) of basal cell carcinoma (BCC).In 2023, the diagnostic yield with dermoscopy was 6.7% (1/15) for melanoma, 51.2% (21/41) for SCC, and 91.6% (22/24) for BCC.Conclusion: Incorporating regular dermoscopy use within general practice, coupled with adequate training, could improve identification of suspicious skin lesions by GPs, resulting in a greater proportion of appropriate referrals to secondary care.This may reduce the burden of the 2WW skin cancer pathway on secondary care whilst improving patient outcomes; further comparative studies are necessary to determine these benefits.