Dermoscopy use in UK primary care: a survey of GPs with a special interest in dermatology

Abstract

Background Melanoma accounts for 90% of skin cancer mortality and typically presents in primary care, where it can be challenging to distinguish from benign lesions. Dermoscopy is a tool for skin visualization that is routinely used for melanoma diagnosis in secondary care. However, the role of dermoscopy in primary care remains unclear. Objectives To determine views on, and use of, dermoscopy by dermatology‐interested general practitioners (GPs). Methods An online questionnaire was emailed to the UK Primary Care Dermatology Society members in February 2018, and responses collected over the following 4 weeks. Results A total of 205 responses were analysed. Most respondents were GPs (94%), aged over 50 (53%), had a postgraduate dermatological qualification (67%) and used dermoscopy regularly when reviewing pigmented skin lesions (97%). Dermoscopy use was commoner amongst GPs who had worked longer in primary care and had experience of secondary care dermatology. Most had undertaken training in dermoscopy (91%), although one‐fifth (20%) had not updated their training in over 5 years. Most of those who had received only 1 day of face‐to‐face training reported feeling confident using a dermatoscope. Few respondents (11%) reported access to teledermatology or teledermoscopy for urgent or routine referrals. Conclusions UK GPs with a special interest in dermatology are routinely using dermoscopy in the primary care setting. More research is needed to establish optimal approaches to training and updating GP dermoscopy skills. When dermoscopy has been shown to be safe, effective, acceptable and cost‐effective in this setting, more GPs may also be able to gain and maintain the skills to implement dermoscopy into routine primary care. Technological advances, including incorporation of artificial intelligence (AI) and algorithms to guide GPs, could also contribute to widening use of dermoscopy among GPs.

Training general practitioners in melanoma diagnosis: a scoping review of the literature

“… 66 One study suggested that 1 day of live training in dermoscopy was sufficient to build the confidence of GPs with special interest in melanoma diagnosis. 67 We found two RCTs that demonstrated sustained improvement in GPs’ diagnostic accuracy, both of which proposed live training in dermoscopy over 1 day or 10 hours. 9 10 Because the duration of training in dermoscopy is a limiting factor for most GPs, it is important to keep in mind that training in clinical melanoma diagnosis has also been shown to improve the GPs’ performances while requiring less training time (in this review, a mean duration of 2.5 hours was observed for clinical diagnostic training programmes).…”

“… 71 In the UK, a survey among GPs with special interest in dermatology stated that self-assessment learning was the most popular for refresher sessions. 67 Nevertheless, they also showed that 36% of GPs who use dermoscopy in their clinical practice reported to have never updated their training skills. We found that the most appreciated form of self-assessment updates was the unlimited access to an e-learning course.…”

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“…The clinical picture of most dermatological diseases is often indistinguishable, so that even dermatologists themselves use further diagnostic tools such as dermatoscopy to certify the diagnosis of a disease and to solve differential diagnostic issues. 22 Short-term education to these diagnostic techniques will be very useful. 23 Since the volume of dermatological diseases is so high, more and more targeted training is needed for general practitioners on these diseases.…”

Dermoscopy in China

“…Professional training is necessary for dermatologists, and dermatologists without training perform no better with a dermoscope than with naked eye examinations. [2] Although regular training courses have been offered, either face-to-face or online, only a small number of dermatologists have received systematic and long-term training. Improving the dermatologist's ability to use a dermoscope is one of the necessary conditions for ensuring the accuracy of disease diagnosis.…”

“…Sub-surface structures such as the epidermis, dermal papilla, and color can be better observed in vivo , by eliminating surface reflection at the skin air interface. [2] Dermoscopy can improve the diagnostic sensitivity for various types of skin disorders without reducing the specificity. [3] In addition, dermoscopy can help dermatologists to better define the tumor margin, measure post-treatment effects and classify diseases.…”