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

Abstract

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.

Dermoscopy use in UK primary care: a survey of GPs with a special interest in dermatology

“…This is likely to be at least partly due to two‐thirds of our respondents reporting a personal history of dermatology posts and qualifications, in keeping with Australian evidence that GP subspecialisation in dermatology leads to increased rates of dermoscopy use . This very high level of dermoscopy use is closer to that of UK dermatologists in 2012 (99%), than for primary care practitioners internationally (34% in Australia in 2007 and 8% in France in 2016), or in our pilot survey of UK GPs without a special interest in dermatology ( n = 77, 17%) (unpublished data). Recent reviews of dermoscopy use for melanoma diagnosis point to an increase in diagnostic accuracy for benign lesions and melanoma when dermoscopy is used by trained GPs, and it can lead to a reduction in unnecessary referrals and excisions.…”

“…However, there is no randomized controlled trial evidence comparing the effects of shorter and longer training periods. Previous studies have found that perceived training requirements are amongst the most commonly cited barriers to implementation of dermoscopy . This study suggests that 1 day of face‐to‐face training is sufficient to enable GPs with a special interest in dermatology to feel confident in dermoscopy use.…”

“…Recent reviews of dermoscopy use for melanoma diagnosis point to an increase in diagnostic accuracy for benign lesions and melanoma when dermoscopy is used by trained GPs, and it can lead to a reduction in unnecessary referrals and excisions. There is also international evidence that GPs are receptive to incorporating dermoscopy into their routine practice …”

“…[18][19][20][21] It is clear that some training is necessary; even amongst dermatologists, dermoscopy without training performs no better than naked eye examination. 11,22,23 Previous studies have surveyed the frequency of dermatoscope use and attitudes towards dermoscopy of primary care practitioners (PCPs) in Australia 16 and France, 24 finding that 34% and 8%, respectively, use dermoscopy; however, there are no such data from GPs in the UK. We therefore aimed to perform a national survey of UK GP views on dermoscopy and chose to set this among dermatology-interested GPs, as they are most likely to have implemented dermoscopy use in primary care.…”

Use of and intentions to use dermoscopy among physicians in the United States

“…There was a 63.5% reduction in the number of benign lesions requiring excision or referral from use of the dermoscopic intervention and sensitivity of diagnosis almost doubled. A recent study of French PCPs provides additional evidence supporting use of the dermascope for melanoma screening [20]. These studies suggest dermoscopy can improve the PCP’s diagnostic accuracy for skin cancer.…”