Expert Consensus Statement on Proficiency Standards for Dermoscopy Education in Primary Care

Tran, Tiffaney; Cyr, Peggy R; Verdieck, Alex; Lu, Miranda D.; Ahrns, Hadjh; Berry, Elizabeth; Bowen, William G.; Braun, Ralph; Cusick-Lewis, Joshua M.; Doan, Hung Q.; Donohue, Valerie L.; Erlich, Deborah R.; Ferris, Laura K.; Harkemanne, Evelyne; Hartman, Rebecca I.; Holt, J. C.; Jaimes, Natalia; Joslin, Timothy A.; Kabaeva, Zhyldyz; Liebman, Tracey N.; Łudzik, Joanna; Marghoob, Ashfaq A.; Simpson, Isac; Stein, Jennifer A.; Stulberg, Daniel L.; Tromme, Isabelle; Turnquist, Matthew J.; Usatine, Richard P.; Walker, Alison M.; Walker, Bryan L.; West, R; Wilson, Megan L.; Witkowski, Alexander; Wu, Dominic J.; Seiverling, Elizabeth V.; Nelson, Kelly C.

doi:10.3122/jabfm.2022.220143r1

Cited by 6 publications

(2 citation statements)

References 33 publications

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“…Recently, Tran et al proposed an expert‐approved list of key dermoscopic features of skin tumours to be taught in training programs for PCPs 57 . We found that all of the core dermoscopic features proposed in their fundamental list of basic skills required to selectively triage benign and malignant skin lesions are taught in the ST.…”

Section: Discussionmentioning

confidence: 76%

“…-28% margin of non-inferiority programs for PCPs. 57 We found that all of the core dermoscopic features proposed in their fundamental list of basic skills required to selectively triage benign and malignant skin lesions are taught in the ST. In the same line of thought, we deliberately excluded from the ST skin tumours that do not present specific dermoscopic features or that are difficult to diagnose using dermoscopy, such as adnexal tumours.…”

Section: F I G U R Ementioning

confidence: 89%

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Evaluation of primary care physicians' competence in selective skin tumour triage after short versus long dermoscopy training: a randomized non‐inferiority trial

Harkemanne

Legrand²,

Sawadogo

et al. 2023

Acad Dermatol Venereol

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Background Although primary care physicians (PCPs) play a key role in skin cancer screening, their skills in detecting malignant tumours is suboptimal. Objectives To determine whether a short dermoscopy e‐learning course (4 h) in skin tumour diagnosis for PCPs is non‐inferior to a long course (12 h) in selective triage of skin lesions. Secondly, to evaluate whether regular refresher training sessions are necessary to maintain the PCPs' skills in the medium term. Methods A randomized 2 × 2 factorial non‐inferiority trial was conducted online over an 8‐month period among 233 PCPs including 126 certified general practitioners, 94 PCPs in training, and 13 occupational physicians, all without prior advanced dermoscopy training. Participants were randomized 1:1:1:1 to receive short training and mandatory refreshers (n = 58), short training and optional refreshers (n = 59), long training and mandatory refreshers (n = 58), or long training and optional refreshers (n = 58). PCPs' skills were evaluated before training (T0), immediately after training (T1) to test the non‐inferiority, and after 5 months (T2) to evaluate the impact of the refreshers. The primary endpoint was the difference in the change of score after short and long training. The non‐inferiority margin was set at −28%. Results Among the 233 randomized participants, 216 (93%) completed T1 and 197 (84.5%) completed T2. For short versus long training, the primary endpoint was 1.392 (95% CI: 0.138; 2.645) in the per‐protocol population (p < 0.001) and 1.016 (95% CI: −0.224; 2.256) in the modified intention‐to‐treat population (p < 0.001). After training, the type of refresher showed no impact on the score (p = 0.840). However, PCPs who completed all refreshers showed the best mean overall score at T2 (p < 0.001). Conclusions These findings confirm that short dermoscopy e‐learning is non‐inferior in training PCPs to triage skin lesions compared to long training. After training, regular refreshers are important to maintain the PCPs' acquired skills over time.

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Section: Discussionmentioning

confidence: 76%

Section: F I G U R Ementioning

confidence: 89%

Evaluation of primary care physicians' competence in selective skin tumour triage after short versus long dermoscopy training: a randomized non‐inferiority trial

Harkemanne

Legrand²,

Sawadogo

et al. 2023

Acad Dermatol Venereol

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Skin Cancer Diagnosis by Lesion, Physician, and Examination Type

Chen,

Fernandez,

Fadadu

et al. 2024

JAMA Dermatol

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ImportanceSkin cancer is the most common cancer in the US; accurate detection can minimize morbidity and mortality.ObjectiveTo assess the accuracy of skin cancer diagnosis by lesion type, physician specialty and experience, and physical examination method.Data SourcesPubMed, Embase, and Web of Science.Study SelectionCross-sectional and case-control studies, randomized clinical trials, and nonrandomized controlled trials that used dermatologists or primary care physicians (PCPs) to examine keratinocytic and/or melanocytic skin lesions were included.Data Extraction and SynthesisSearch terms, study objectives, and protocol methods were defined before study initiation. Data extraction was performed by a reviewer, with verification by a second reviewer. A mixed-effects model was used in the data analysis. Data analyses were performed from May 2022 to December 2023.Main Outcomes and MeasuresMeta-analysis of diagnostic accuracy comprised sensitivity and specificity by physician type (primary care physician or dermatologist; experienced or inexperienced) and examination method (in-person clinical examination and/or clinical images vs dermoscopy and/or dermoscopic images).ResultsIn all, 100 studies were included in the analysis. With experienced dermatologists using clinical examination and clinical images, the sensitivity and specificity for diagnosing keratinocytic carcinomas were 79.0% and 89.1%, respectively; using dermoscopy and dermoscopic images, sensitivity and specificity were 83.7% and 87.4%, and for PCPs, 81.4% and 80.1%. Experienced dermatologists had 2.5-fold higher odds of accurate diagnosis of keratinocytic carcinomas using in-person dermoscopy and dermoscopic images compared with in-person clinical examination and images. When examining for melanoma using clinical examination and images, sensitivity and specificity were 76.9% and 89.1% for experienced dermatologists, 78.3% and 66.2% for inexperienced dermatologists, and 37.5% and 84.6% for PCPs, respectively; whereas when using dermoscopy and dermoscopic images, sensitivity and specificity were 85.7% and 81.3%, 78.0% and 69.5%, and 49.5% and 91.3%, respectively. Experienced dermatologists had 5.7-fold higher odds of accurate diagnosis of melanoma using dermoscopy compared with clinical examination. Compared with PCPs, experienced dermatologists had 13.3-fold higher odds of accurate diagnosis of melanoma using dermoscopic images.Conclusions and RelevanceThe findings of this systematic review and meta-analysis indicate that there are significant differences in diagnostic accuracy for skin cancer when comparing physician specialty and experience, and examination methods. These summary metrics of clinician diagnostic accuracy could be useful benchmarks for clinical trials, practitioner training, and the performance of emerging technologies.

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