Sensitivity and Specificity for Skin Cancer Diagnosis in Primary Care Providers: a Systematic Literature Review and Meta-analysis of Educational Interventions and Diagnostic Algorithms

Gonna, Nadeen; Tran, Tiffaney; Bassett, Roland L.; Farris, David; Nelson, Kelly C.

doi:10.1007/s13187-022-02194-4

Cited by 4 publications

(5 citation statements)

References 38 publications

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“…sunsmart.org.nz/), and the upskilling of primary care practitioners in the use of dermoscopy, which can increase diagnostic accuracy and reduce unnecessary excisions. 10 Many general practitioners, nurses and others have attended short courses on skin lesion recognition and management. Commercial organisations provide sequential digital dermoscopic and mole mapping services directly to patients.…”

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confidence: 99%

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Elwood,

Rademaker

2024

NZMJ

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Section: Good News About Melanomamentioning

confidence: 99%

Good news about melanoma

Elwood,

Rademaker

2024

NZMJ

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“…Specific educational training programs, 11–14 including dermoscopy training, have demonstrated to enhance PCPs' diagnostic accuracy and management of skin cancer 15–18 . Nevertheless, dermoscopy is currently used very little by PCPs 19–21 probably due to lack of adequate training opportunities and to the long training duration required to become competent 22–25 …”

Section: Introductionmentioning

confidence: 99%

“…Specific educational training programs, [11][12][13][14] including dermoscopy training, have demonstrated to enhance PCPs' diagnostic accuracy and management of skin cancer. [15][16][17][18] Nevertheless, dermoscopy is currently used very little by PCPs [19][20][21] probably due to lack of adequate training opportunities and to the long training duration required to become competent. [22][23][24][25] In 2016, the Triage Amalgamated Dermoscopic Algorithm (TADA) was specifically created for non-experts to triage skin lesions suspicious of malignancy using dermoscopy.…”

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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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“…These approaches include educational interventions, dermoscopy, reflectance confocal microscopy, optical coherence tomography, multiphoton excited fluorescence imaging, and others. [11][12][13][14] However, significant barriers to their use in primary care include the need of specialized training, high cost of implementation, and generally a lack of comprehensive validating evidence. [11][12][13] A long-standing challenge is to develop new technologies for the early diagnosis of skin cancer, which are non-invasive and accurate, easy to use, and cost-effective for general practice.…”

Section: Introductionmentioning

confidence: 99%

Clinical Utility of an AI-powered, Handheld Elastic Scattering Spectroscopy Device on the Diagnosis and Management of Skin Cancer by Primary Care Physicians

Jaklitsch,

Thames,

de Campos Silva

et al. 2023

J Prim Care Community Health

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Background: Patients with lesions suspicious for skin cancer often present to primary care physicians (PCPs), who may have limited training in skin cancer diagnosis. Objective: To measure the impact of an adjunctive handheld device for PCPs that employs elastic scattering spectroscopy (ESS) on the diagnosis and management of skin cancer. Methods: Fifty-seven PCPs evaluated 50 clinical images of skin lesions (25 malignant and 25 benign), first without and then with knowledge of the handheld ESS device output, and in each case indicated if a lesion was likely to be benign or malignant. Results: The diagnostic sensitivity of the PCPs with and without the use of the ESS device was 88% (95% CI, 84%-92%) and 67% (95% CI, 62%-72%), respectively ( P < .0001). In contrast, no significant difference was observed in the diagnostic specificity. The management sensitivity of the physicians with and without the use of the ESS device was 94% (95% CI, 91%-96%) and 81% (95% CI, 77%-85%), respectively ( P = .0009). Similarly, no significant difference was observed in the management specificity. Conclusion: The use of the ESS device may have the potential to help improve skin cancer diagnosis and confidence in management decision-making in a primary care setting.

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Sensitivity and Specificity for Skin Cancer Diagnosis in Primary Care Providers: a Systematic Literature Review and Meta-analysis of Educational Interventions and Diagnostic Algorithms

Cited by 4 publications

References 38 publications

Good news about melanoma

Good news about melanoma

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

Clinical Utility of an AI-powered, Handheld Elastic Scattering Spectroscopy Device on the Diagnosis and Management of Skin Cancer by Primary Care Physicians

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