Examination of skin lesions for cancer: Which clinical decision aids and tools are available in general practice?

Koelink, Cecile; Jonkman, Marcel F.; Meer, Klaas van der; Heide, Wouter K. van der

doi:10.1684/ejd.2014.2275

Cited by 12 publications

(13 citation statements)

References 114 publications

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“…They scored their confidence in their clinical diagnosis of skincare at 5 out of 10. This fact has previously been reported in several studies in different countries . Previous experience in the diagnosis of skin cancer seemed to facilitate diagnostic capability .…”

Section: Discussionsupporting

confidence: 65%

Dermoscopy, a useful tool for general practitioners in melanoma screening: a nationwide survey

et al. 2016

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Summary Background Dermoscopy improves diagnostic accuracy in melanoma, as shown by several meta‐analyses. Although it is used by general practitioners (GPs) in Australia, Canada and Italy, no published data on this topic are available in France. Objectives To review the opinions and use of dermoscopy by GPs in France and to understand their practice of skin examination. Methods We designed a descriptive and cross‐sectional survey and conducted it between 26 November and 26 December 2014. An anonymous, multiple‐choice questionnaire about the demographic characteristics, skin examination modalities and use and training in dermoscopy was sent to 4057 GPs in four large regions of France. Pearson, χ2, Student, Welch and Fisher tests were used for cross‐tabulation statistical analysis. Results Only 8% of respondents had access to a dermoscope; most were male practitioners and aged > 50 years. Dermoscopy increased self‐confidence in analysing pigmented lesions (P = 0·004), and dermoscopy users referred fewer patients to dermatologists. The number of biopsies was reduced in the dermoscopy users group (P = 0·004). In total, 425 questionnaires were returned and analysed. Dermoscopy users took more time to evaluate a single pigmented lesion (P = 0·015). Only 16·9% of physicians declared having received some training on dermoscopy, yet this number reached 47% for those owning a dermoscope. Their training was mostly short and recent. Overall 29·2% of the respondents said the main advantage was to reduce the number of referrals to the dermatologists (P = 0·004), while its main disadvantage was the necessity of training (54·6%). Our responders declared they could spend seven working days on a dermoscopy training course. Conclusions Our study demonstrates positive opinions regarding dermoscopy, despite a minority of French GPs using this technique in the areas surveyed. The need for formal training appears to be the main limitation to wider use. Appropriate and specifically designed training programmes should be offered.

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Section: Discussionsupporting

confidence: 65%

Dermoscopy, a useful tool for general practitioners in melanoma screening: a nationwide survey

et al. 2016

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“…To our knowledge, there are no proven clinical tools available to PCPs for evaluating nonpigmented skin lesions. 20 …”

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confidence: 99%

A Clinical Aid for Detecting Skin Cancer: The Triage Amalgamated Dermoscopic Algorithm (TADA)

Rogers

Marino

Dusza

et al. 2016

The Journal of the American Board of Family Medicine

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Purpose Family physicians (FPs) frequently evaluate skin lesions but may not have the necessary training to accurately and confidently identify lesions that require skin biopsy or specialist referral. We evaluated the diagnostic performance of a new, simplified dermoscopy algorithm for skin cancer detection. Methods In this cross-sectional, observation study, attendees of a dermoscopy course evaluated 50 polarized dermoscopy images of skin lesions (27 malignant and 23 benign) using the Triage Amalgamated Dermoscopic Algorithm (TADA). The dermoscopic criteria of TADA include architectural disorder (ie, disorganized or asymmetric distribution of colors and/or structures), starburst pattern, blue-black or gray color, white structures, negative network, ulcer, and vessels. The study occurred after 1 day of basic dermoscopy training. Clinical information related to palpation (ie, firm, dimpling) was provided when relevant. Results Of 200 course attendees, 120 (60%) participated in the study. Participants included 64 (53.3%) dermatologists and 41 (34.2%) primary care physicians, 19 (46.3%) of whom were FPs. Fifty-two (43%) individuals had no previous dermoscopy training. Overall, the sensitivity and specificity of TADA for malignant skin lesions was 94.8% and 72.3%, respectively. Previous dermoscopy training and years of dermoscopy experience were not associated with diagnostic sensitivity (P = .13 and P = .05, respectively) or specificity (P = .36 and P = .21, respectively). Specialty type was not associated with sensitivity (P = .37) but dermatologists had a higher specificity than nondermatologists (79% v. 72%, P = .008). Conclusions After basic instruction, TADA may be a useful dermoscopy algorithm for FPs who examine skin lesions as it has a high sensitivity for detecting skin cancer.

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“…Their specificity rate also was in the range of reported rates . Of note, melanoma diagnosis by PCPs has been reported to have a sensitivity of 42–100% and specificity of 33·1–90·6% . The accuracy or appropriate patient referral by PCP to a dermatologist has a sensitivity of 70–88% and specificity of 70–87%.…”

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confidence: 80%

“…The 2014 article by Koelink et al . tried to address this question by analysing clinical aids and tools used within general practice . They concluded that clinically validated tools were lacking in primary care and suggested that clinical trials were needed to determine the value of clinical decision aids (e.g.…”

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confidence: 99%

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Automated diagnosis: shedding the light on skin cancer

Raphael

Soyer

2018

Br J Dermatol

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Examination of skin lesions for cancer: Which clinical decision aids and tools are available in general practice?

Cited by 12 publications

References 114 publications

Dermoscopy, a useful tool for general practitioners in melanoma screening: a nationwide survey

Dermoscopy, a useful tool for general practitioners in melanoma screening: a nationwide survey

A Clinical Aid for Detecting Skin Cancer: The Triage Amalgamated Dermoscopic Algorithm (TADA)

Automated diagnosis: shedding the light on skin cancer

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