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PCP-based skin cancer screening feasible

Primary care-based skin cancer training and screening is feasible, and may improve primary care physician diagnostic accuracy, according to recently published study results in JAMA Dermatology.

Researchers studied patients aged 35 years or older scheduled for an annual health habits screen in the primary care practitioner general clinics through a pilot intervention study at the Veterans Affairs Palo Alto Health Care System.

Six primary care physicians (PCPs) voluntarily completed a 1.5-hour web-based training for skin cancer detection on May 1, 2015. Five of the PCPs conducted patient screenings during a 14-month period from June 18, 2015, to Aug. 30, 2016.

There were 258 patients (median age, 70 years; 98.8% men) offered screenings, including 52 who had a documented history of melanoma or keratinocyte carcinoma. Among those offered screening, 189 (77.3%) received a clinical skin examination and 69 declined.

Sixty-two patients (32.8%) were referred to a dermatologist after screening, including 33 for presumptive skin cancers and 15 for precancers.

Nine patients underwent skin biopsies; four had melanoma in situ, basal cell carcinoma and/or squamous cell carcinoma.

PCPs made correct diagnosis in 13 of 38 patients (34.2%).

“Comparison of all outpatient visits for the five main participating PCPs before vs. after invention revealed no significant differences in dermatology referrals overall and those for presumptive skin cancer or actinic keratoses, skin biopsies or PCP diagnostic accuracy with the exception of significantly fewer postintervention dermatology referrals that lacked specific diagnoses (25 [1.0%] vs. 10 [0.4%], P = .01),” the researchers wrote.

“Our study suggests that primary care-based skin cancer screening is feasible and may be performed without substantial associated harms in a population at risk for advanced melanomas and [keratinocyte carcinomas], although time constraints remain an obstacle for PCPs,” the researchers concluded. – by Bruce Thiel

Disclosure: The researchers report no relevant financial disclosures.