With increasing incidence and mortality of melanoma, better recognition and management by primary care providers (PCPs) becomes more important. Historically, studies suggest PCPs would benefit from additional education leading to effective early detection which is still the best hope for cutting melanoma deaths by at least half in the near future.

According to a new national study from Henry Ford Hospitalin Detroit PCPs who took an online training course about skin cancer detection significantly improved their skill to properly diagnose and manage benign and malignant lesions. The study, funded by the Melanoma Research Alliance, shows that physicians? enhanced skill level also led to a reduction in unnecessary referrals to dermatology specialists.The findings of the study are published in the online issues of the Journal of the American Board of Family Medicine[1]

Conventional education programs have had the effect of stabilizing mortality rates despite steadily increasing incidence trends, but we need to change our methods to get a substantial reduction in deaths.

The INternet curriculum FOR Melanoma Early Detection or Informed study is believed to be the first of its kind to track physician practice patterns as an outcome of a skin cancer detection training course. The results of the study shows that the scores for diagnosing and managing all skin cancer lesions increased 10%. Other key factors include:

  • Scores for diagnosing benign lesions increased 14%;
  • Patient referrals for suspicious lesions or new visits to a dermatology specialist declined as the result of improved detection by primary care physicians;
  • Physicians still retained their improved skill level six months later.

?We all know the demands on a physician?s time. But this online course shows that we can empower primary care physicians to know when they themselves can take care of some of these patients and have the confidence in doing so, and not drive up the cost of utilization with unnecessary referrals to a dermatologist,? says Melody Eide, M.D., a Henry Ford dermatologist and the study?s lead author.

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Each year, there are more new cases of skin cancer than the combined incidence of breast, prostate, lung and colon cancers, according to the Skin Cancer Foundation. Treatment of nonmelanoma skin cancers has increased by nearly 77 percent between 1992 and 2006. Meanwhile, incidence rates of melanoma ? the most serious form of skin cancer ? have been increasing for at least 30 years. It is estimated that one in 50 Americans will develop melanoma by 2015.

Improving skills
Given these disconcerting trends, researchers sought to evaluate whether PCPs could diagnose skin cancer if provided targeted, specific education. This is important because PCPs see more patients than any other physician group. However, fewer than 30% of primary care residents receive training for performing a skin examination during their medical training.

?Improving PCPs skills at diagnosing and managing skin lesions is an important way to improve patient care because patients frequently bring skin complaints to their family doctor,? Eide noted.

Online training
The web-based course[2]covered the three most common skin cancers ? basal cell carcinoma, squamous cell carcinoma and melanoma, and featured 450 clinical images of lesions. The participants chose from two web options – traditional textbook format and case-based format, which took about two to three hours to complete. The case-based format featured nine case studies with interactive self-assessment tests and immediate feedback.

Before taking the course in 2011, participants took a pretest of 25 images of skin lesions in which they had to choose a diagnosis and course of action ? reassure or refer. Participants were assessed a post-test immediately after completing the course, then repeated six months later.?Their post-test scores were much higher than their pre-test scores,? Eide said. ?The scores suggest that prior to taking the course, the participants had the most difficulty distinguishing between benign and malignant skin lesions. But taking the course improved their ability to do so.?

The Informedstudy involved nine U.S. health care institutions: Henry Ford Hospital, Kaiser Permanente, Harvard Medical School, Harvard Pilgrim Health Care Institute, Harvard School of Public Health, Memorial Sloan-Kettering Cancer Center, Veterans Affairs Medical Center, Rhode Island Hospital and Brown University.

For more information
[1] Eide MJ, Asgari MM, Fletcher SW, Geller AC, Halpern AC, Shaikh WR, Li L, et al. Effects on Skills and Practice from a Web-Based Skin Cancer Course for Primary Care Providers. J Am Board Fam Med Nov/Dec 2013; 26 (6) 648-657 [Article]
[2] Informed skin cancer education series Overview]

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