Diagnostic tools used for melanoma: A survey of Australian general practitioners and dermatologists

Nguyen, Jennifer; Ting, Sarajane; Paul, Eldho; Smith, Andrea L.; Watts, Caroline; Kelly, John W.; Cust, Anne E.; Mar, Victoria

doi:10.1111/ajd.13595

Cited by 4 publications

(8 citation statements)

References 55 publications

(126 reference statements)

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“…A lower than expected response rate was also considered a limitation of this study however this is not uncommon for surveys involving medical practitioners who may be time poor. Similar trends have been observed in previous studies that examined similar population groups in Australia 32,33 . It is also acknowledged that some of the results represented, despite being statistically significant, had relatively wide confidence intervals due to the study sample size and therefore larger studies would be required for greater precision of effect size.…”

Section: Discussionsupporting

confidence: 84%

“…Similar trends have been observed in previous studies that examined similar population groups in Australia. 32,33 It is also acknowledged that some of the results represented, despite being statistically significant, had relatively wide confidence intervals due to the study sample size and therefore larger studies would be required for greater precision of effect size.…”

Section: Strengths and Limitationsmentioning

confidence: 99%

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Stage IA melanoma follow‐up: Exploring the level of confidence of South Australian general practitioners in undertaking surveillance skin checks including considerations for shared care

2023

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Background The literature highlights the role of Australian general practitioners (GP) in the management of skin cancers. With melanoma incidences on the rise, there have been discussions into whether lower‐risk stage IA patients could safely be followed up by their GPs for annual surveillance full skin examinations (FSE). This study explores the level of confidence of South Australian (SA) GPs in undertaking FSEs including factors that could support discussions around shared care between GPs and dermatology units for lower‐risk patients. Methods An online survey was designed and distributed to SA GPs via email, newsletters and social media between 5 December 2021 and 30 January 2022. Descriptive statistics were used to describe survey responses. Pearson's Chi‐squared analysis was used to investigate associations between key variables of interest and explanatory variables. Logistic regression analysis was used to model odds ratios for associations between the dependent variable and independent variables. Results A total of 135 responses were obtained. Forty‐four per cent of GPs were comfortable undertaking annual FSEs, 41% were uncomfortable and 15% were unsure. Scope of work, >20 years experience and additional training had statistically significant relationships (p < 0.05). Dermoscopy and detecting melanoma recurrences were reported to be skills with lower levels of confidence. With regards to shared care, 77% indicated that they would feel supported undertaking FSEs if rapid access referral pathways were allocated for patients who developed suspicious lesions. Preferred upskilling modalities included, face‐to‐face sessions in a dermatology unit (39%), dermatologist run webinars (25%) and certificate courses (20%). Conclusions At present, there is a subset of SA GPs who are comfortable undertaking FSEs and therefore could be engaged in shared care with specialists. Further considerations have to be made in the areas of upskilling and supporting the workforce to enhance engagement in shared care.

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Section: Discussionsupporting

confidence: 84%

Section: Strengths and Limitationsmentioning

confidence: 99%

Stage IA melanoma follow‐up: Exploring the level of confidence of South Australian general practitioners in undertaking surveillance skin checks including considerations for shared care

2023

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“…1 To improve the accuracy and timely diagnosis of melanoma while minimising biopsies of benign lesions, various diagnostic tools have been developed including dermoscopy, sequential digital dermoscopic imaging (SDDI) and total body photography (TBP). 2 TBP involves systematic photography of the entire skin surface which can then be used in subsequent examinations to identify new lesions and macroscopic changes in pre-existing lesions. 3 Dermoscopy has been shown to increase diagnostic accuracy and reduce unnecessary excisions of benign lesions.…”

Section: Introductionmentioning

confidence: 99%

“…Early recognition and treatment of cutaneous melanoma is associated with better prognostic outcomes 1 . To improve the accuracy and timely diagnosis of melanoma while minimising biopsies of benign lesions, various diagnostic tools have been developed including dermoscopy, sequential digital dermoscopic imaging (SDDI) and total body photography (TBP) 2 . TBP involves systematic photography of the entire skin surface which can then be used in subsequent examinations to identify new lesions and macroscopic changes in pre‐existing lesions 3 .…”

Section: Introductionmentioning

confidence: 99%

Evaluation of dynamic dermoscopic features of melanoma and benign naevi by sequential digital dermoscopic imaging and total body photography in a high‐risk Australian cohort

et al. 2023

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Background/Objectives Sequential digital dermoscopic imaging (SDDI) and total body photography (TBP) are recommended as a two‐step surveillance method for individuals at high‐risk of developing cutaneous melanoma. Dermoscopic features specific to melanoma have been well described, however, dynamic changes on serial imaging are less understood. This study aims to identify and compare dermoscopic features in developing melanomas and benign naevi that underwent SDDI and TBP to understand which dermoscopic features may be associated with a malignant change. Method Histopathology reports from a private specialist dermatology clinic from January 2007 to December 2019 were reviewed. Histopathologically confirmed melanoma and benign naevi that underwent SDDI and TBP with a minimum follow‐up interval of 3 months were included. Results Eighty‐nine melanomas (38.2% invasive, median Breslow thickness 0.35 mm, range: 0.2–1.45 mm) and 48 benign naevi were evaluated by three experienced dermatologists for dermoscopic changes. Features most strongly associated with melanoma included the development of neovascularisation, asymmetry and growth in pigment network, additional colours, shiny white structures, regression, structureless areas and change to a multi‐component pattern. The presence of atypical vessels (p = 0.02) and shiny white structures (p = 0.02) were significantly associated with invasive melanoma. Conclusion Evaluation for certain evolving dermoscopic features in melanocytic lesions monitored by SDDI and TBP is efficient in assisting clinical decision making. SDDI with TBP is an effective tool for early detection of melanoma.

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“…The involvement of general practitioners (GPs) in melanoma screening is already part of routine care in countries where the incidence of skin tumors is particularly high [ 14 , 15 , 16 , 17 ]. Although several initiatives in Europe are urging GP involvement, the practice is not widespread in many countries [ 18 , 19 , 20 , 21 ].…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2022

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Introduction: The incidence of melanoma increased considerably in recent decades, representing a significant public health problem. We aimed to evaluate the ability of non-specialists for the preliminary screening of skin lesions to identify melanoma-suspect lesions. Materials and Methods: A medical student and a dermatologist specialist examined the total body scans of 50 patients. Results: The agreement between the expert and the non-specialist was 87.75% (κ = 0.65) regarding the assessment of clinical significance. The four parameters of the ABCD rule were evaluated on the 129 lesions rated as clinically significant by both observers. Asymmetry was evaluated similarly in 79.9% (κ = 0.59), irregular borders in 74.4% (κ = 0.50), color in 81.4% (κ = 0.57), and diameter in 89.9% (κ = 0.77) of the cases. The concordance of the two groups was 96.9% (κ = 0.83) in the case of the detection of the Ugly Duckling Sign. Conclusions: Although the involvement of GPs is part of routine care worldwide, emphasizing the importance of educating medical students and general practitioners is crucial, as many European countries lack structured melanoma screening training programs targeting non-dermatologists.

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Diagnostic tools used for melanoma: A survey of Australian general practitioners and dermatologists

Cited by 4 publications

References 55 publications

Stage IA melanoma follow‐up: Exploring the level of confidence of South Australian general practitioners in undertaking surveillance skin checks including considerations for shared care

Stage IA melanoma follow‐up: Exploring the level of confidence of South Australian general practitioners in undertaking surveillance skin checks including considerations for shared care

Evaluation of dynamic dermoscopic features of melanoma and benign naevi by sequential digital dermoscopic imaging and total body photography in a high‐risk Australian cohort

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

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