• Dallas R English, Robert C Burton, Chris B del Mar, Robert J Donovan, Paul D Ireland, and Geoff Emery.
• The Cancer Council Victoria, Carlton, VIC 3053, Australia. dallas.english@cancervic.org.au
• BMJ. 2003 Aug 16;327(7411):375.

ObjectivesTo determine whether an aid to the diagnosis of pigmented skin lesions reduces the ratio of benign lesions to melanomas excised in general practice.DesignControlled trial randomised by practice.SettingGeneral practices in Perth, Western Australia.Participants468 general practitioners in 223 practices.InterventionsIntervention practices were given an algorithm and instant camera to assist with the diagnosis of pigmented skin lesions. All practices were given national guidelines on managing melanoma.Main Outcome MeasuresRatio of benign pigmented lesions to melanomas excised. Analyses conducted with and without inclusion of seborrhoeic keratoses.ResultsAt baseline the ratios of benign to malignant lesions were lower in the intervention group than in the control group. During the trial period the ratios were higher in the intervention group (19:1 v 17:1 without seborrhoeic keratoses and 29:1 v 26:1 with seborrhoeic keratoses). After adjustment for patients' age, sex, and socioeconomic status, the ratio was 1.02 times higher (95% confidence interval 0.68 to 1.51, P = 0.94) in the intervention group when seborrhoeic keratoses were not included and 1.03 times higher (0.71 to 1.50, P = 0.88) when seborrhoeic keratoses were included. General practitioners in the intervention group were less likely than those in the control group to excise the most recent pigmented skin lesion they managed (22% v 48%, P < 0.001) and to refer the patient to a specialist (16% v 27%, P = 0.06).ConclusionsProvision of the algorithm and camera did not decrease the ratio of benign pigmented skin lesions to melanomas excised by general practitioners.

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