Journal Information
Vol. 98. Issue 3.
Pages 171-177 (April 2007)
Vol. 98. Issue 3.
Pages 171-177 (April 2007)
Original article
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Minor cutaneous ambulatory surgery and cryotherapy. Comparative study between a dermatologist and family physicians
Cirugía Menor Ambulatoria Dermatológica y Crioterapia. Estudio Comparativo Entre un Dermatólogo y Médicos de Familia
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J. Graellsa,
Corresponding author
26449jge@comb.es

Correspondence: Salvat Papasseit 58-62, 2-1, 08830 Sant Boi de Llobregat, Barcelona, Spain.
, A. Espinolab, C. Barriob, M.D. Muñozb, A. Románb, N. Parelladab
a Servicio de Dermatología, Hospital Comarcal de Sant Boi de Llobregat, Barcelona, Spain
b Médico de Familia, Asistencia Primaria, Districte Baix Llobregat Litoral, Barcelona, Spain
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Abstract
Introduction

Lack of diagnostic skill in cutaneous surgery may lead to erroneous and potentially detrimental therapies. This study compares the diagnosis and treatment in cutaneous surgery, including cryotherapy, between a dermatologist and family physicians.

Methods

It is an observational, prospective study on a random sample of patients that consulted the dermatologist for candidate lesions. Each lesion was independently evaluated by a dermatologist and a family physician, both of whom assigned the clinical diagnosis and therapeutic advice. Concordance for diagnosis, recommended treatment and indication for cryotherapy was calculated by Cohen's kappa coefficient.

Results

Six hundred forty-six lesions were evaluated. Global kappa indexes were 0.69 (95% CI, 0.65-0.73) for diagnostic concordance, 0.62 (95% CI, 0.56-0.67) for recommended treatment and 0.73 (95% CI, 0.67-0.78) for indication of cryotherapy. Diagnostic concordance was significantly better for melanocytic nevus, achrocordon and for lesions with multiple and monomorphous presentation, and worse for isolated pigmented lesions. For recommended treatment concordance was better for multiple and monomorphous lesions and worse for skin cancer and seborrheic keratosis. For indication of cryotherapy concordance was worse for skin cancer, melanocytic nevus, acrochordon and seborrheic keratosis. Family physicians made an erroneous indication for cryotherapy in 5.88% of cases, including 3 non melanoma skin cancers.

Conclusions

Concordance between dermatologists and family physicians for minor cutaneous surgery is generally good. Family physicians should be more careful in evaluating solitary pigmented lesions and patients at risk for skin cancer.

Key words:
clinical competence
family physicians
Primary Care
minor surgery
cryotherapy
Resumen
Introducción

En cirugía dermatológica, una menor habilidad diagnóstica podría conducir a tratamientos erróneos y potencialmente perjudiciales. En este trabajo se compara el diagnóstico y la decisión terapéutica en cirugía dermatológica, incluyendo la crioterapia, entre un dermatólogo y médicos de familia.

Métodos

Estudio prospectivo observacional, sobre una muestra no seleccionada de pacientes que consultan al dermatólogo por lesiones candidatas. Cada lesión fue evaluada independientemente por un dermatólogo y un médico de familia, consignando ambos el diagnóstico clínico y el consejo terapéutico. Se calculó la concordancia para el diagnóstico, tratamiento recomendado e indicación de crioterapia mediante el estadístico kappa de Cohen.

Resultados

Se evaluaron 646 lesiones. Los índices kappa globales fueron 0,69 (intervalo de confianza [IC] del 95%, 0,65-0,73) en concordancia diagnóstica, 0,62 (IC del 95%, 0,56-0,67) en tratamiento recomendado y 0,73 (IC del 95%, 0,67-0,78) en indicación de crioterapia. La concordancia diagnóstica resultó significativamente mejor en nevus melanocítico, acrocordón y en lesiones con presentación múltiple y monomorfa, y peor en lesiones pigmentadas aisladas. En tratamiento recomendado fue mejor para lesiones múltiples y monomorfas, y peor en cáncer de piel y queratosis seborreica. En indicación de crioterapia fue peor en cáncer de piel, nevus melanocítico, acrocordón y queratosis seborreica. Los médicos de familia indicaron crioterapia incorrectamente en el 5,88% de casos, incluyendo tres cánceres de piel no melanoma.

Conclusiones

La concordancia entre dermatólogos y médicos de familia en cirugía menor dermatológica es en general buena. Los médicos de familia deberían ser cautos en lesiones pigmentadas solitarias y pacientes de riesgo para cáncer de piel.

Palabras clave:
competencia clínica
médicos de familia
Atención Primaria
cirugía menor
crioterapia
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Copyright © 2007. Academia Española de Dermatología y Venereología and Elsevier España, S.L.
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