Dermoscopy in general practice: a retrospective study on its role in effective skin cancer assessment and 2WW referrals

Background 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 has the potential to make GPs proficient diagnosticians of skin lesions, leading to a more effective 2WW (2 week wait) referral pathway for skin cancer. Aim To assess the 2WW pathway’s effectiveness for skin lesions in primary care, where a GP incorporated dermoscopy within skin lesion assessment. Method This was a retrospective observational study within a general practice surgery in London, UK. A total of 4,658 patients had their skin lesions assessed by a single GP using a dermoscope within a mole clinic at a general practice surgery between 1 January 2020 and 31 December 2024. There were 575 2WW referrals, with data collected from EMIS, an NHS patient database. Results Over 60 months (01/01/2020 to 31/12/2024), 4,658 patients underwent dermoscopic assessment, resulting in 575 (12%) 2WW referrals. Of the 2WW referrals, 275 (48%) 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%) of basal cell carcinoma (BCC). In 2023, the diagnostic accuracy while using dermoscopy was 6.3% (1/16) for melanoma, 49% (21/43) for SCC and 92% (22/24) for BCC. Conclusion Incorporating regular dermoscopy use within primary care alongside adequate training, could result in more efficient GP diagnosticians, reducing the burden of the 2WW pathway on secondary care while improving patient outcomes.