To the Editor: In a recent article, Youl and colleagues provided information about the ability of doctors to accurately diagnose skin lesions that they excise or biopsy.1 We wish to offer some comments about their comparison between general practitioners and skin cancer clinic doctors.

First, in the study by Youl et al the behaviour of GPs and patients in mainstream practice was different from that of doctors and patients in skin cancer clinics, as indicated by the comparative frequency of whole body skin examinations performed (GPs, 30.4%; skin cancer clinic doctors, 73.2%).1 The study did not indicate the circumstances under which each decision to excise took place. Did patients become aware of a new or changing skin lesion and bring it to the attention of the doctor, or did the diagnosis result from a whole body skin check that might have revealed an earlier, previously unnoticed and more subtle lesion? It may be useful to separate basal cell carcinoma (BCC) and squamous cell carcinoma (SCC) into histological subtypes, as early superficial BCC and intraepidermal SCC may be more difficult to diagnose than other subtypes.2