EFFECT OF DERMOSCOPY TRAINING IN CANADIAN PRIMARY CARE PHYSICIANS: STEP I OF THE TRIAGE AMALGAMATED DERMOSCOPY ALGORITHM (TADA)

Abstract

Abstract: Background: Accurate identification of cutaneous lesions is an essential skill for family medicine physicians (FMP). Numerous studies show significant improvement in the diagnostic accuracy of skin cancer detection and reduction in benign lesion biopsy with dermoscopy use. As the first point of access to medical care, FMP represent an ideal group in which to provide dermoscopy training. Objective: Develop and deliver introductory dermoscopy training modules to assess the diagnostic accuracy of step I of the Triage Amalgamated Dermoscopic Algorithm (TADA) to Canadian FMP. Methods: Cross over, observational study of 33 dermoscopy naïve FMP attending a 3.5 hour educational workshop. Participants analyzed 50 cases each containing a clinical and corresponding dermoscopic photographic image of skin lesions of which 41 were pigmented (19 malignant, 22 benign) and 9 non-pigmented (8 malignant, 1 benign). Lesions were identified as having features of one of the three TADA step I lesions (angioma, dermatofibroma, seborrheic keratosis) or none of these in identical assessments prior to and after teaching. The differences in percentage of correct responses in detecting TADA I and non-TADA I lesions were calculated and compared from pre-and post-teaching analyses. Results: Pre-to post-teaching analyses showed improvements in: 1) Diagnostic accuracy, as defined by this study, for all lesions assessed from 76.0% (n=1178) to 90.8% (n=1407); for all TADA I lesions combined by 6.4% (83.9%, n=364 to 90.0%, n=392); angioma by 6.5% (90.3%, n=140 to 96.8%, n=150); dermatofibroma by 8.9% (89.5%, n=111 to 98.4%, n=122); seborrheic keratosis by 4.5% (72.9%, n=113 to 77.4%, n=120) 2) Correct classification of number of malignancies as non-TADA step I lesions from 78.4% (n=656) to 94.7% (n=793); 3) False positive rates for TADA I lesions of malignant status decreased for angioma from 5.1% (n=43) to 1.0% (n=8); dermatofibroma 5.4% (n=45) to 2.2% (n=18) and seborrheic keratosis 11.1% (n=93) to 2% (n=17) and for the malignant melanoma subgroup from 23% (n=114) to 5.2% (n=26); 4) Number of benign lesions biopsied unnecessarily from 26.8% (n=191) to 13.9% (n=99). Conclusions: Results of this study suggest that introductory dermoscopy training improves the diagnostic accuracy of benign and malignant lesions consistent with published preliminary studies on use of TADA as a triage tool with high sensitivity and specificity beneficial for novice users.

Datum der Bewilligung	2020
Originalsprache	Englisch
Gradverleihende Hochschule	Medizinische Universität Graz
Betreuer/-in	Andreas Blum (Betreuer*in)