Teaching Skin Cancer Detection to Medical Students Using a Dermoscopic Algorithm

Abstract

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.

Implementation of a dermatoscopy curriculum during residency at Augsburg University Hospital in Germany

“…A significant improvement was found between the pre‐ and posttest scores for all participants and for the residents. These results are consistent with other studies, even though there were different educational methods or other subgroups investigated 9,11,35–37 . In the pretest the highest results were achieved by the specialists and the lowest by the medical students.…”

Expert Consensus Statement on Proficiency Standards for Dermoscopy Education in Primary Care

“…31 Training programs based on TADA have been shown to improve the sensitivity for skin cancer detection compared with baseline. [29][30][31][32] Given the proven effectiveness of TADA in training PCPs and novices, 33 diagnoses in level 2 are mostly considered less common in the general population and/or more challenging to discern (eg, pigmented actinic keratosis, lichen planus-like keratosis). Level 2 also incorporates different types of melanoma (eg, lentigo maligna melanoma, amelanotic/hypomelanotic melanoma) and benign nevi (eg, blue nevi, acral nevi) and demonstrates a broader utility of dermoscopy in the identification of other diagnoses frequently encountered by PCPs (eg, molluscum contagiosum, psoriasis).…”

impact of primary care physicians’ education about easy skin lesion diagnosis algorithm on skin cancers screening effects

“…Peggy R. Cyr w swoim opracowaniu opisuje istotny statystycznie wzrost wyniku testu z rozpoznawania zmian skórnych przed i po 90-minutowym szkoleniu z Triage Amalgamated Dermoscopy Algorithm. [22] W swojej badaniu Elizabeth Seiverling również zaobserwowała istotny wzrost poprawnych diagnoz po szkoleniu 59 lekarzy z rozpoznawania zmian skórnych według TADA. Czułość diagnostyczna wzrosła z 62,5% do 88,1% [2], a uczestnicy budowali większą pewność w rozpoznawaniu nowotworów [23].…”