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Using the 7-point checklist as a diagnostic aid for pigmented skin lesions in general practice: a diagnostic validation study

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Fiona M. Walter, Toby Prevost, Joana Carvalho De Vasconcelos, Per N. Hall, Nigel P. Burrows, Helen C. Morris, Ann Louise Kinmonth, Jon D. Emery

Original languageEnglish
Pages (from-to)e345-e353
Number of pages9
JournalBritish Journal of General Practice
Issue number610
PublishedMay 2013


King's Authors



GPs need to recognise significant pigmented skin lesions, given rising UK incidence rates for malignant melanoma. The 7-point checklist (7PCL) has been recommended by NICE (2005) for routine use in UK general practice to identify clinically significant lesions which require urgent referral.


To validate the Original and Weighted versions of the 7PCL in the primary care setting.

Design and setting

Diagnostic validation study, using data from a SIAscopic diagnostic aid randomised controlled trial in eastern England.


Adults presenting in general practice with a pigmented skin lesion that could not be immediately diagnosed as benign were recruited into the trial. Reference standard diagnoses were histology or dermatology expert opinion; 7PCL scores were calculated blinded to the reference diagnosis. A case was defined as a clinically significant lesion for primary care referral to secondary care (total 1436 lesions: 225 cases, 1211 controls); or melanoma (36).


For diagnosing clinically significant lesions there was a difference between the performance of the Original and Weighted 7PCLs (respectively, area under curve: 0.66, 0.69, difference = 0.03, P


The Original and Weighted 7PCLs both performed well in a primary care setting to identify clinically significant lesions as well as melanoma. The Weighted 7PCL, with a revised cut-off score of 4 from 3, performs slightly better and could be applied in general practice to support the recognition of clinically significant lesions and therefore the early identification of melanoma.

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