Diagnosing skin cancer in primary care: how do main-stream general practitioners compare with primary care skin cancer clinic doctors?

In reply: We thank Heal and Raasch, and Keir for their comments and suggestions. First, as acknowledged in our article, it is possible that general practitioners with an interest in skin cancer may have been over-represented in our sample. It is also the case that the comparison between GPs and skin cancer clinic doctors may have been affected by characteristics of patients attending each type of practice. Patients attending skin cancer clinics are self-selected (often worried about a specific skin lesion), while for those attending GPs in mainstream practice, skin lesions are more likely mentioned during a consultation for something else.1 Case selection, which helps increase diagnostic ability by Bayesian principles (improving pretest probability of malignant lesions), may thus be more likely for skin cancer clinic doctors than GPs.2