Skin Cancer Screening with the Use of Dermoscopy in Primary Care
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Abstract
According to the American Cancer Society (ACS) (2018), skin cancer is the most common type of cancer in the United States. Though rare, melanoma is the skin cancer linked with the highest mortality rate (The Skin Cancer Foundation, 2019). However, skin cancer screenings fall well below levels of other routine cancer screenings and over half of patients who were referred to a dermatologist for a suspicious lesion were eventually diagnosed with skin cancer in a location other than the referral site (Bruner & Schaffer, 2012; Kownacki, 2014). Compared to naked eye examinations, dermoscopy has led to earlier detection of melanoma and other cancerous skin lesions like squamous cell carcinoma and basal cell carcinoma (Marghoob & Jaimes, 2019).
Barriers to full body skin examination include lack of time at office visits, preoccupation with competing co-morbidities, and a lack of expertise in lesion identification. Providers feel there is a lack of training and exposure to skin examination, causing a decreased confidence in diagnosing suspicious lesions (Curiel-Lewandrowski, Chen, & Swetter, 2012; Hershcorn, 2012; Shellenberger et al., 2018). Hencley (2017) found that comfortability, knowledge, and usefulness of dermoscopy increased after implementing a two-hour dermoscopy training and practice seminar. In this practice improvement project, an educational seminar and resource surrounding the practice of dermoscopy was created for rural primary care providers (PCPs) in North Dakota and Minnesota.
The purpose of the practice improvement project was to train and educate rural PCPs about the practice of dermoscopy with the aim to improve their knowledge and comfortability with clinical application of dermoscopy. Pre- and post-dermoscopy education surveys compared the PCPs’ knowledge level of dermoscopy, general skin cancer topics, their opinions on their comfortability with the practice of dermoscopy, and the usefulness of dermoscopy. Ultimately, the goal was that rural PCPs will develop dermoscopy skills to increase accuracy in the management of skin lesions prior to patients having to travel to urban dermatology clinics. Overall, the practice improvement project found that dermoscopy knowledge, comfortability, and usefulness increased after the two-hour dermoscopy training course.