Diagnosis of Cutaneous Melanoma: the Gap Between the Knowledge of General Practitioners and Dermatologists in a Brazilian Population

Garrido, Andrea Quadros; Wainstein, Alberto Julius Alves; Brandão, Marina Patrus Ananias; Santos, Fernando Augusto de Vasconcellos; Bittencourt, Flávia Vasques; Ledsham, Carolina; Drummond-Lage, Ana Paula

doi:10.1007/s13187-020-01735-z

Cited by 3 publications

(10 citation statements)

References 24 publications

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“…8 Furthermore, the population's lack of knowledge about skin cancer signs and symptoms is crucial in delaying diagnosis since patients do not recognize the alarm signs, taking longer to seek a consultation. 4,7,9 Besides this, patients who recognize melanoma symptoms waited an average of 1 year before referring to a physician for evaluation and establishing the diagnosis. 10 GPs' misdiagnoses regarding suspicious lesions are also known to contribute to delays in diagnosis.…”

Section: T a B L Ementioning

confidence: 99%

“…So, it is essential to emphasize the need to expand knowledge about melanoma in academic and continuing education programs for health professionals. 4,10,11 The age range of patients, low schooling, socioeconomic conditions, and geographical issues are also potential factors for delay in starting oncologic treatment. 12 Most patients depend on ambulances or group transportation to access the reference cancer centre, with long trips, sometimes in precarious vehicles, increasing patients' suffering.…”

Section: T a B L Ementioning

confidence: 99%

“…Thus, it is crucial to ensure and expand the population's and GP's knowledge about melanoma. 4,6 Moreover, the low effectiveness is mainly because it considers only the period between the diagnosis and the beginning of treatment. The most critical period is the long pilgrimage required of SUS users, from the beginning of the signs and symptoms to the access to care and the performance of the necessary exams for the precise diagnosis of cancer.…”

Section: T a B L Ementioning

confidence: 99%

“…These difficulties may be related to patients' and GP's lack of awareness about skin cancer signs and symptoms, and the bureaucracies inherent to the SUS, culminating in advanced disease with a low chance of cure. 4 In 2012 the Brazilian Government enacted the '60-day Law' (Law 12,732/12), which defined that a patient diagnosed with cancer has the right to undergo the first treatment at SUS within 60 days from the date of diagnosis. This represents an attempt to shorten the time between diagnosis and treatment and contribute to a higher probability of a patient's cure, decreasing morbidity and mortality.…”

Section: Introductionmentioning

confidence: 99%

“…However, several obstacles hinder the optimal management of these patients at SUS. These difficulties may be related to patients' and GP's lack of awareness about skin cancer signs and symptoms, and the bureaucracies inherent to the SUS, culminating in advanced disease with a low chance of cure 4 …”

Section: Introductionmentioning

confidence: 99%

See 4 more Smart Citations

Is a law enough to provide a better prognosis for Brazilian melanoma patients or education is still a gap?

Marcelino

Soares

Curi

et al. 2022

Health Planning & Management

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According to Brazilian Law 12.732/12 ("60-day law"), cancer patients have 60 days after diagnosis for beginning treatment at the Unified Health System (SUS). The study aimed to evaluate the achievement and effectiveness of the '60-day law' for melanoma patients in a SUS cancer reference unit. A retrospective study analysed 58 medical charts from patients with the initial diagnosis performed before and after the "60-day law". The Law does not change the time interval between diagnosis and the beginning of treatment, and after the Law, patients presented a worse overall survival (p < 0.001). In conclusion, the '60-day law' was not effective.

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Section: T a B L Ementioning

confidence: 99%

Section: T a B L Ementioning

confidence: 99%

Section: T a B L Ementioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Is a law enough to provide a better prognosis for Brazilian melanoma patients or education is still a gap?

Marcelino

Soares

Curi

et al. 2022

Health Planning & Management

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Factors Related to Delayed Diagnosis of Cutaneous Melanoma in the Brazilian Public Health System

et al. 2022

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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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Diagnosis of Cutaneous Melanoma: the Gap Between the Knowledge of General Practitioners and Dermatologists in a Brazilian Population

Cited by 3 publications

References 24 publications

Is a law enough to provide a better prognosis for Brazilian melanoma patients or education is still a gap?

Is a law enough to provide a better prognosis for Brazilian melanoma patients or education is still a gap?

Factors Related to Delayed Diagnosis of Cutaneous Melanoma in the Brazilian Public Health System

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

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