scholarly journals Training Primary Care Physicians in Dermoscopy for Skin Cancer Detection: a Scoping Review

2019 ◽  
Vol 35 (4) ◽  
pp. 643-650 ◽  
Author(s):  
Jonathan A. Fee ◽  
Finbar P. McGrady ◽  
Cliff Rosendahl ◽  
Nigel D. Hart
Keyword(s):  
Primary Care ◽  
Skin Cancer ◽  
Cancer Detection ◽  
Primary Care Physicians ◽  
Training Programs ◽  
Meta Analysis ◽  
Skin Lesions ◽  
Evidence Base ◽  
Care Physician ◽  
Skin Cancer Detection

AbstractIn many countries, patients with concerning skin lesions will first consult a primary care physician (PCP). Dermoscopy has an evidence base supporting its use in primary care for skin cancer detection, but need for training has been cited as a key barrier to its use. How PCPs train to use dermoscopy is unclear. A scoping literature review was carried out to examine what is known from the published literature about PCP training in dermoscopy. The methodological steps taken in this review followed those described by Arksey and O’Malley, as revised by Levac et al. Four electronic databases were searched for evidence published up to June 2018. Sixteen articles were identified for analysis, all published since 2000. Ten training programs were identified all of which addressed dermoscopy of pigmented skin lesions, among other topics. Ten articles reported on a range of outcomes measured after training and showed generally positive results in terms of improved diagnostic performance, although no meta-analysis was conducted. However, it was unclear whether trained PCPs continued to use dermoscopy after training. Observational questionnaire data revealed that many PCPs use dermoscopy in practice without any formal training. The literature generally supports the use of dermoscopy by PCPs, but it is unclear whether current training leads to long-term change in PCPs’ use of dermoscopy in clinical practice. Understanding this problem, as well as exploring PCPs’ training needs, is essential to develop training programs that will facilitate the uptake and use of dermoscopy in primary care.

scholarly journals Teaching Skin Cancer Detection to Medical Students Using a Dermoscopic Algorithm

PRiMER ◽  
2021 ◽  
Vol 5 ◽  
Author(s):  
Peggy R. Cyr ◽  
Wendy Craig ◽  
Hadjh Ahrns ◽  
Kathryn Stevens ◽  
Caroline Wight ◽  
...  
Keyword(s):  
Primary Care ◽  
Medical Students ◽  
Skin Cancer ◽  
Primary Care Physicians ◽  
Survival Rates ◽  
Family Physicians ◽  
Skin Lesions ◽  
Posttest Score ◽  
Malignant Skin ◽  
Attending Physicians

Introduction: Early detection of melanoma skin cancer improves survival rates. Training family physicians in dermoscopy with the triage amalgamated dermoscopic algorithm (TADA) has high sensitivity and specificity for identifying malignant skin neoplasms. In this study we evaluated the effectiveness of TADA training among medical students, compared with practicing clinicians. Methods: We incorporated the TADA framework into 90-minute workshops that taught dermoscopy to family physicians, primary care residents, and first- and second-year medical students. The workshop reviewed the clinical and dermoscopic features of benign and malignant skin lesions and included a hands-on interactive session using a dermatoscope. All participants took a 30-image pretest and a different 30-image posttest. Results: Forty-six attending physicians, 25 residents, and 48 medical students participated in the workshop. Mean pretest scores were 20.1, 20.3, and 15.8 for attending physicians, resident physicians and students, respectively (P<.001); mean posttest scores were 24.5, 25.9, and 24.1, respectively (P=.11). Pre/posttest score differences were significant (P<.001) for all groups. The medical students showed the most gain in their pretest and posttest scores. Conclusion: After short dermoscopy workshop, medical students perform as well as trained physicians in identifying images of malignant skin lesions. Dermoscopy training may be a valuable addition to the medical school curriculum as this skill can be used by primary care physicians as well as multiple specialists including dermatologists, gynecologists, otolaryngologists, plastic surgeons, and ophthalmologists, who often encounter patients with concerning skin lesions.

scholarly journals Dermoscopy Improves Accuracy of Primary Care Physicians to Triage Lesions Suggestive of Skin Cancer

2006 ◽  
Vol 24 (12) ◽  
pp. 1877-1882 ◽  
Author(s):  
Giuseppe Argenziano ◽  
Susana Puig ◽  
Iris Zalaudek ◽  
Francesco Sera ◽  
Rosamaria Corona ◽  
...  
Keyword(s):  
Primary Care ◽  
Skin Cancer ◽  
Primary Care Physicians ◽  
Randomized Study ◽  
Skin Lesions ◽  
Skin Cancer Screening ◽  
Predictive Values ◽  
Naked Eye ◽  
Pigmented Lesions ◽  
Malignant Skin Tumors

Purpose Primary care physicians (PCPs) constitute an appropriate target for new interventions and educational campaigns designed to increase skin cancer screening and prevention. The aim of this randomized study was to determine whether the adjunct of dermoscopy to the standard clinical examination improves the accuracy of PCPs to triage lesions suggestive of skin cancer. Patients and Methods PCPs in Barcelona, Spain, and Naples, Italy, were given a 1-day training course in skin cancer detection and dermoscopic evaluation, and were randomly assigned to the dermoscopy evaluation arm or naked-eye evaluation arm. During a 16-month period, 73 physicians evaluated 2,522 patients with skin lesions who attended their clinics and scored individual lesions as benign or suggestive of skin cancer. All patients were re-evaluated by expert dermatologists at clinics for pigmented lesions. Referral accuracy of both PCP groups was calculated by their scores, which were compared to those tabulated for dermatologists. Results Referral sensitivity, specificity, and positive and negative predictive values were 54.1%, 71.3%, 11.3%, and 95.8%, respectively, in the naked-eye arm, and 79.2%, 71.8%, 16.1%, and 98.1%, respectively, in the dermoscopy arm. Significant differences were found in terms of sensitivity and negative predictive value (P = .002 and P = .004, respectively). Histopathologic examination of equivocal lesions revealed 23 malignant skin tumors missed by PCPs performing naked-eye observation and only six by PCPs using dermoscopy (P = .002). Conclusion The use of dermoscopy improves the ability of PCPs to triage lesions suggestive of skin cancer without increasing the number of unnecessary expert consultations.

scholarly journals Benefits of Teledermatology for Geriatric Patients: Population-Based Cross-Sectional Study

10.2196/16700 ◽  
2020 ◽  
Vol 22 (4) ◽  
pp. e16700 ◽  
Author(s):  
Mara G Bianchi ◽  
Andre Santos ◽  
Eduardo Cordioli
Keyword(s):  
Primary Care ◽  
Health Care ◽  
Primary Care Physician ◽  
Primary Care Physicians ◽  
Malignant Tumors ◽  
Skin Lesions ◽  
Care Physician ◽  
Pigmentary Disorders ◽  
The World ◽  
Skin Conditions

Background Teledermatology is a health care tool that has been increasingly used around the world, mostly because dermatology has an emphasis on visual diagnosis. Many studies have shown that access to specialized care improves using teledermatology, which provides accurate diagnosis and reduces the time taken for treatment, with high patient satisfaction. As the population around the world grows old, there will be even more demand for dermatologists in years to come. It is essential to know which are the most prevalent skin conditions in the primary care population and if they can be addressed through teledermatology. Objective Our main goal was to evaluate the proportion of lesions in individuals aged 60 years and older that could be managed using teledermatology in conjunction with primary care physicians. Second, we aimed to assess the most frequent skin lesions, the most common treatments provided to patients, and the distribution and causes of referrals made by the teledermatologists. Methods This was a retrospective cohort study from July 2017 to July 2018 in São Paulo, Brazil. We included 6633 individuals aged 60 years and older who presented with 12,770 skin lesions. Teledermatologists had three options to refer patients: (1) to undergo biopsy directly, (2) to an in-person dermatologist visit, and (3) back to the primary care physician with the most probable diagnosis and treatment. Results Teledermatology managed 66.66% (8408/12614) of dermatoses with the primary care physician without the need for an in-presence visit; 27.10% (3419/12614) were referred to dermatologists, and 6.24% (787/12614) directly to biopsy. The most frequent diseases were seborrheic keratosis, solar lentigo, onychomycosis, melanocytic nevus, benign neoplasms, actinic keratosis, epidermoid cyst, xerosis, leucoderma, and wart, with significant differences between sexes. Malignant tumors increased with age and were the leading cause for biopsies, while infectious skin conditions and pigmentary disorders decreased. Emollient was the most frequent treatment prescribed, in 31.88% (909/2856) of the cases. Conclusions Teledermatology helped to treat 67% of the dermatoses of older individuals, addressing cases of minor complexity quickly and conveniently together with the primary care physician, thus optimizing dermatological appointments for the most severe, surgical, or complex diseases. Teledermatology does not aim to replace a face-to-face visit with the dermatologist; however, it might help to democratize dermatological treatment access for patients and decrease health care expenses.

scholarly journals Benefits of Teledermatology for Geriatric Patients: Population-Based Cross-Sectional Study (Preprint)

2019 ◽  
Author(s):  
Mara G Bianchi ◽  
Andre Santos ◽  
Eduardo Cordioli
Keyword(s):  
Primary Care ◽  
Health Care ◽  
Primary Care Physician ◽  
Primary Care Physicians ◽  
Malignant Tumors ◽  
Skin Lesions ◽  
Care Physician ◽  
Pigmentary Disorders ◽  
The World ◽  
Skin Conditions

BACKGROUND Teledermatology is a health care tool that has been increasingly used around the world, mostly because dermatology has an emphasis on visual diagnosis. Many studies have shown that access to specialized care improves using teledermatology, which provides accurate diagnosis and reduces the time taken for treatment, with high patient satisfaction. As the population around the world grows old, there will be even more demand for dermatologists in years to come. It is essential to know which are the most prevalent skin conditions in the primary care population and if they can be addressed through teledermatology. OBJECTIVE Our main goal was to evaluate the proportion of lesions in individuals aged 60 years and older that could be managed using teledermatology in conjunction with primary care physicians. Second, we aimed to assess the most frequent skin lesions, the most common treatments provided to patients, and the distribution and causes of referrals made by the teledermatologists. METHODS This was a retrospective cohort study from July 2017 to July 2018 in São Paulo, Brazil. We included 6633 individuals aged 60 years and older who presented with 12,770 skin lesions. Teledermatologists had three options to refer patients: (1) to undergo biopsy directly, (2) to an in-person dermatologist visit, and (3) back to the primary care physician with the most probable diagnosis and treatment. RESULTS Teledermatology managed 66.66% (8408/12614) of dermatoses with the primary care physician without the need for an in-presence visit; 27.10% (3419/12614) were referred to dermatologists, and 6.24% (787/12614) directly to biopsy. The most frequent diseases were seborrheic keratosis, solar lentigo, onychomycosis, melanocytic nevus, benign neoplasms, actinic keratosis, epidermoid cyst, xerosis, leucoderma, and wart, with significant differences between sexes. Malignant tumors increased with age and were the leading cause for biopsies, while infectious skin conditions and pigmentary disorders decreased. Emollient was the most frequent treatment prescribed, in 31.88% (909/2856) of the cases. CONCLUSIONS Teledermatology helped to treat 67% of the dermatoses of older individuals, addressing cases of minor complexity quickly and conveniently together with the primary care physician, thus optimizing dermatological appointments for the most severe, surgical, or complex diseases. Teledermatology does not aim to replace a face-to-face visit with the dermatologist; however, it might help to democratize dermatological treatment access for patients and decrease health care expenses.

scholarly journals The Clinical Utility of a Handheld Elastic Scattering Spectroscopy Tool and Machine Learning in the Diagnosis and Referral Management of Skin Cancer by Primary Care Physicians (Preprint)

2021 ◽  
Author(s):  
Kelly Tepedino ◽  
Todd Thames
Keyword(s):  
Primary Care ◽  
Clinical Study ◽  
Elastic Scattering ◽  
Skin Cancer ◽  
Primary Care Physicians ◽  
Standard Of Care ◽  
Skin Lesions ◽  
Second Phase ◽  
Device Performance ◽  
Elastic Scattering Spectroscopy

BACKGROUND Elastic scattering spectroscopy (ESS) is a noninvasive optical biopsy technique that can distinguish between normal and abnormal tissue in vivo. The handheld device measures ESS spectra of skin lesions and classifies lesions with an output of “Investigate Further” or “Monitor.” The algorithm was trained and validated with over 11,000 spectral scans from over 3500 skin lesions. The device performance was also evaluated in an associated clinical study. OBJECTIVE The aim of this paper was to establish whether the use of a handheld ESS tool can improve the detection of skin malignancies by evaluating clinical performance while emulating a real-world telemedicine clinical care setting. METHODS The associated clinical study examined an independent test set of 332 lesions in a prospective multicenter study that compared algorithm performance to biopsy results for diagnosing malignant lesions. A total of 50 cases were randomly selected from the study data base (25 malignant and 25 benign lesions). Device performance on these lesions had a 96% sensitivity. High-resolution digital images and the patient’s clinical information including prior skin cancer history, risk factors, and physical examination results were available for evaluation. A total of 57 primary care physicians participated in this study in 2 phases, the first phase with their standard-of-care diagnostic and the second phase regarding their evaluation with the device output. The physicians were educated on the ESS device before evaluating the cases in a random order. Case evaluation included the physician reporting their diagnosis, management decision, and confidence level without the device output in the first phase and with the device output in the second phase. The results were evaluated for sensitivity and specificity with confidence intervals. RESULTS The diagnostic sensitivity of the readers without and with the use of the handheld ESS device increased significantly from 67% to 88% (<i>P</i>&lt;.001). There was no significant difference in specificity at 40% and 53% (<i>P</i>=.05). The management sensitivity of the readers increased significantly with and without the use of the device, which, respectively, was 94% (91%-96%) and 81% (77%-85%) (<i>P</i>&lt;.001), suggesting that the use of the device may reduce false negatives by 68%. Specificity was comparable for management decisions (<i>P</i>=.36) at 31% compared to 36% without the device. CONCLUSIONS The use of the handheld ESS device significantly improved diagnostic and management sensitivity over standard-of-care, with comparable specificity. While telemedicine has shown promise in many fields, studies have shown that in-person skin evaluation is superior to telemedicine evaluations; however, integration with this type of tool has the potential to improve early detection.

scholarly journals Dermoscopy Use in Primary Care: A Scoping Review

2019 ◽  
pp. 98-104 ◽  
Author(s):  
Jonathan A. Fee ◽  
Finbar P. McGrady ◽  
Cliff Rosendahl ◽  
Nigel D. Hart
Keyword(s):  
Primary Care ◽  
Skin Lesions ◽  
Evidence Base ◽  
Care Physician ◽  
Perceived Barriers ◽  
Current State ◽  
Published Evidence ◽  
Scoping Literature Review ◽  
Dramatic Rise ◽  
Questionnaire Studies

Background: Patients in many countries with new or changing skin lesions will first consult a primary care physician, often called a general practitioner (GP). With the dramatic rise in melanoma incidence over recent decades, dermoscopy offers a tool with an evidence base supporting its use in skin lesion assessment. How GPs use dermoscopy is unclear. Objectives: A scoping literature review was carried out to examine the current state of published evidence about dermoscopy use in primary care. Methods: The methodological steps taken in this review followed those developed by Arksey and O’Malley, as revised by Levac and colleagues. Four electronic databases were searched for evidence published up to January 2018 describing the use of dermoscopy in a generalist primary care setting. Seven articles were identified for analysis. Results: All included articles have been published since 2007. Most were questionnaire studies and revealed that generally a small minority of GPs use dermoscopy, although some jurisdictions such as Australia report greater use. Dermoscopy is generally used only for the assessment of pigmented skin lesions, but is not used consistently. Several perceived barriers to dermoscopy use, including the need for training, have been reported. Conclusions: There is a paucity of data on dermoscopy use among GPs, and diversity in questionnaire items prevents comparison between jurisdictions. Perceived barriers to dermoscopy use require more in-depth exploration, potentially including qualitative data, to evaluate them more fully. Understanding these factors, including how GPs train in dermoscopy, will be crucial in widening dermoscopy use in primary care.

scholarly journals Real-Time Mobile-Phone-Aided Melanoma Skin Lesion Detection Using Triangulation Technique

2020 ◽  
Vol 11 (3) ◽  
pp. 9-31
Author(s):  
Kumud Tiwari ◽  
Sachin Kumar ◽  
R. K. Tiwari
Keyword(s):  
Skin Cancer ◽  
Skin Lesion ◽  
Cancer Detection ◽  
Mobile Application ◽  
Laboratory Testing ◽  
Skin Lesions ◽  
Lesion Detection ◽  
Detection Accuracy ◽  
Skin Cancer Detection ◽  
Melanoma Skin

Melanoma is a harmful disease among all types of skin cancer. Genetic factors and the exposure of UV rays causes melanoma skin lesions. Early diagnosis is important to identify malignant melanomas to improve the patient prognosis. A biopsy is a traditional method which is painful and invasive when used for skin cancer detection. This method requires laboratory testing which is not very efficient and time-consuming to detect skin lesions. To solve the above issue, a computer aided diagnosis (CAD) for skin lesion detection is needed. In this article, we have developed a mobile application with the capabilities to segment skin lesions in dermoscopy images using a triangulation method and categorize them into malignant or bengin lesions through a supervised method which is convolution neural network (CNN). This mobile application will make the skin cancer detection non-invasive which does not require any laboratory testing, making the detection less time consuming and inexpensive with a detection accuracy of 81%.

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