Dermoscopy use in primary care: a qualitative study with general practitioners

Abstract

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.

Melanoma Detection by Non-Specialists: An Untapped Potential for Triage?

“…Our results align with previous studies assessing the specificity and sensitivity of GPs for melanoma screening [ 14 , 29 ]. Although we found similar results when assessing the diagnostic accuracy of macroscopic and dermoscopic evaluation separately, previous studies reported that combining naked-eye and dermoscopic assessment can increase diagnostic accuracy [ 19 , 30 , 31 , 32 , 33 ]. However, as the first step of non-specialist involvement in screening, implementing macroscopic assessment of the whole skin surface of the patients in daily practice would be more reasonable than implementing dermoscopic assessment, as it has no special asset requirements [ 31 , 33 ].…”

Publication Trends of Qualitative Research in Dermatology

“…Figure 1 shows the PRISMA flow diagram of the selection criteria. A total of 1398 studies were screened, and 249 studies (17.8%) were ultimately included in the database …”

impact of primary care physicians’ education about easy skin lesion diagnosis algorithm on skin cancers screening effects

“…[16,17] Badania pokazują, że koszt zakupu własnego dermatoskopu może być barierą dla wielu lekarzy rodzinnych, jednak gdy urządzenie jest dostępne w miejscu pracy odsetek lekarzy chętnych do szkolenia i używania dermatoskopii w codziennej diagnostyce rośnie. [18].…”