In many countries, patients with concerning skin lesions will first consult a primary care physician (PCP). Dermoscopy has an evidence base supporting its use in primary care for skin cancer detection, but need for training has been cited as a key barrier to its use. How PCPs train to use dermoscopy is unclear. A scoping literature review was carried out to examine what is known from the published literature about PCP training in dermoscopy. The methodological steps taken in this review followed those described by Arksey and O'Malley, as revised by Levac et al. Four electronic databases were searched for evidence published up to June 2018. Sixteen articles were identified for analysis, all published since 2000. Ten training programs were identified all of which addressed dermoscopy of pigmented skin lesions, among other topics. Ten articles reported on a range of outcomes measured after training and showed generally positive results in terms of improved diagnostic performance, although no metaanalysis was conducted. However, it was unclear whether trained PCPs continued to use dermoscopy after training. Observational questionnaire data revealed that many PCPs use dermoscopy in practice without any formal training. The literature generally supports the use of dermoscopy by PCPs, but it is unclear whether current training leads to long-term change in PCPs' use of dermoscopy in clinical practice. Understanding this problem, as well as exploring PCPs' training needs, is essential to develop training programs that will facilitate the uptake and use of dermoscopy in primary care.

Background Skin assessments constitute a significant proportion of consultations with family physicians (commonly called general practitioners or GPs in the UK), and referrals to hospital dermatology departments have risen significantly in recent years. Research has shown that dermoscopy use may help GPs to assess and triage skin lesions, including suspected skin cancers, more accurately. However, dermoscopy is used by a small minority of GPs in the UK. Previous questionnaire studies have aimed to establish in a limited way some perceptions of dermoscopy among GPs: this study aimed to explore more deeply the factors influencing the use of dermoscopy among GPs. Methods This was a qualitative interview study set in UK general practice. A purposive sample was taken of GPs who were established dermoscopy users, GPs who had recently adopted dermoscopy, and those who did not use dermoscopy. A total of twelve semi-structured interviews were conducted. Audio-recordings were transcribed verbatim and analysed using a thematic analysis (Braun and Clarke). Results GPs’ capability to use dermoscopy necessitated receiving adequate training, while previous dermatology experience and support from colleagues were also considered factors that enabled dermoscopy use. The impact of dermoscopy on patient consultations about skin complaints was generally considered to be positive, as was having an ‘in-house’ dermoscopy user within a GP practice to refer patients to. However, training in dermoscopy was not considered a priority for many GPs either due to other more pressing concerns within their practices or the perceived complexity of dermoscopy, alongside barriers such as equipment costs. Significant ethical concerns with posting patient photographs online for training and teaching purposes were also highlighted. Conclusions Both GPs who use dermoscopy, and those who do not, consider it to have an important role in improving skin assessments within primary care. However the need for adequate training in dermoscopy and dermatology more generally was highlighted as a key barrier to its wider use. The development of competency standards for the use of dermoscopy could allow the adequacy of training to be assessed and developed.

Background: Patients in many countries with new or changing skin lesions will first consult a primary care physician, often called a general practitioner (GP). With the dramatic rise in melanoma incidence over recent decades, dermoscopy offers a tool with an evidence base supporting its use in skin lesion assessment. How GPs use dermoscopy is unclear. Objectives: A scoping literature review was carried out to examine the current state of published evidence about dermoscopy use in primary care. Methods: The methodological steps taken in this review followed those developed by Arksey and O’Malley, as revised by Levac and colleagues. Four electronic databases were searched for evidence published up to January 2018 describing the use of dermoscopy in a generalist primary care setting. Seven articles were identified for analysis. Results: All included articles have been published since 2007. Most were questionnaire studies and revealed that generally a small minority of GPs use dermoscopy, although some jurisdictions such as Australia report greater use. Dermoscopy is generally used only for the assessment of pigmented skin lesions, but is not used consistently. Several perceived barriers to dermoscopy use, including the need for training, have been reported. Conclusions: There is a paucity of data on dermoscopy use among GPs, and diversity in questionnaire items prevents comparison between jurisdictions. Perceived barriers to dermoscopy use require more in-depth exploration, potentially including qualitative data, to evaluate them more fully. Understanding these factors, including how GPs train in dermoscopy, will be crucial in widening dermoscopy use in primary care.

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