Underperformance in Skin Cancer Practices Despite Good Knowledge and Attitudes Among Primary Care Physicians.

Background: Primary care physicians play an important role in the early recognition, prevention, and referral of suspicious skin lesions. However, data on their preparedness to address skin cancer in Saudi Arabia remain limited. Methods: In this nationwide cross-sectional study, primary care physicians completed an anonymous online questionnaire assessing knowledge, attitudes, practices, and perceived barriers. Knowledge was assessed using 27 items scored as correct or incorrect (range 0-27), with adequate knowledge defined a priori as ≥17/27 (≥60%). Attitudes were assessed using seven statements rated on a three-point agreement scale, scored 0-2 each (range 0-14), with positive attitudes defined as ≥10/14 (≥70%). Practice was summarised using a 0-5 index representing the number of recommended skin cancer-related behaviours performed, with proper practice defined as ≥3/5. Perceived barriers were assessed as a separate domain using the same three-point agreement format. Multivariable logistic regression was used to identify factors associated with proper practice. Results: A total of 159 primary care physicians were included. Mean knowledge and attitude scores were 20.9 ± 3.2 and 11.2 ± 1.9, respectively, and 90.6% and 89.3% met thresholds for adequate knowledge and positive attitudes. In contrast, the mean practice index was 2.0 ± 1.4, and only 34.6% met the definition of proper practice. Only 24.5% had performed a full-body skin examination for skin cancer screening, 23.3% routinely counseled patients on sun protection, 20.8% used diagnostic tools for suspicious lesions, and 32.7% had attended skin cancer-related continuing medical education. Training attendance and more years in practice were independently associated with proper practice. The most frequently reported barriers were lack of access to diagnostic tools (74.2%) and absence of clear clinical protocols for skin cancer screening or management (69.2%). Conclusion: Primary care physicians showed good knowledge and positive attitudes regarding skin cancer, but practice remained suboptimal. Improving training, clinical guidance, and access to diagnostic tools may strengthen skin cancer prevention and early detection in primary care.