Dermoscopy Training Effect on Diagnostic Accuracy of Skin Lesions in Canadian Family Medicine Physicians Using the Triage Amalgamated Dermoscopic Algorithm.

Andreas Blum,Ashfaq A Marghoob,Donald T Wigle,Elizabeth A Sawyers

doi:10.5826/dpc.1002a35

Abstract

Accurate identification of cutaneous lesions is an essential skill for family medicine physicians (FMPs). Studies show significant improvement in skin cancer detection with dermoscopy use. Frontline FMPs are an ideal target group for dermoscopy training. The 3-step Triage Amalgamated Dermoscopic Algorithm (TADA) facilitates high sensitivity and specificity for pigmented and nonpigmented skin lesions. Step I requires unequivocal identification of dermoscopic features for 1 of 3 benign skin lesions: angioma, dermatofibroma, or seborrheic keratosis. If absent, steps II and III are applied assessing for features of architectural disorder and malignancies with organized, symmetric patterns, respectively. To assess FMPs' diagnostic accuracy of benign and malignant skin lesions before and after training in TADA step I. In this repeated-measures observational study, 33 dermoscopy-naive FMPs attending an introductory dermoscopy workshop each assessed gross and corresponding dermoscopic photographic images of 50 pigmented and nonpigmented skin lesions (23 benign, 27 malignant) for features of TADA step I lesions before and after training. Analyses compared diagnostic accuracy in relation to training and baseline physician characteristics. Diagnostic accuracy improved from 76.4% to 90.8% (P < 0.001) and from 85.0% to 90.0% (P = 0.01), respectively, for all lesions and for all TADA I lesions. Female sex was significant as a predictor of individual posttraining performance (all lesions combined, P = 0.02). Results show significant improvement in diagnostic accuracies for benign and malignant skin lesions with introductory dermoscopy training using TADA step I. This will reduce unnecessary benign lesion excision and enhance referral sensitivity, conserving specialist resources.

Highlights

Skin cancer is the most common of all Canadian cancers, with more than 80,000 cases diagnosed yearly [1]
Results: Diagnostic accuracy improved from 76.4% to 90.8% (P < 0.001) and from 85.0% to 90.0%
As Canadian dermoscopy training opportunities are sparse for family medicine physicians (FMPs), our objective was to develop and test introductory educational modules for Triage Amalgamated Dermoscopic Algorithm (TADA) step I in a group of FMPs. This repeated-measures study conducted in Ottawa, Canada, included 33 dermoscopy-naive FMPs voluntarily responding to a mass mailing invitation to a 3.5-hour introductory dermoscopy workshop without compensation

Summary

Introduction

Skin cancer is the most common of all Canadian cancers, with more than 80,000 cases diagnosed yearly [1]. Frontline family medicine physicians (FMPs) are ideally positioned to identify cutaneous lesions with malignant potential. Dermoscopy is an inexpensive, noninvasive tool shown to significantly improve diagnostic accuracies of benign and malignant skin lesions compared with naked eye examination among FMPs and dermatologists [4,5,6]. Eliminate requirements for specific diagnoses, asking users to distinguish benign from potentially malignant lesions, the latter necessitating biopsy or referral [10,11]. Accurate identification of cutaneous lesions is an essential skill for family medicine physicians (FMPs). The 3-step Triage Amalgamated Dermoscopic Algorithm (TADA) facilitates high sensitivity and specificity for pigmented and nonpigmented skin lesions. Step I requires unequivocal identification of dermoscopic features for 1 of 3 benign skin lesions: angioma, dermatofibroma, or seborrheic keratosis. Steps II and III are applied assessing for features of architectural disorder and malignancies with organized, symmetric patterns, respectively

Methods

Results

Discussion

Conclusion