Improved dermoscopy training in residency should be prioritized

Dermoscopy training and education should be prioritized in resident education to increase melanoma detection, according to a study published in JAMA Dermatology.

“Dermoscopy use facilitates the detection of earlier-stage melanomas compared with visual inspection alone,” Lauren J. Fried, BS, of the Ronald O. Perelman Department of Dermatology, NYU Grossman School of Medicine, and colleagues wrote. “Dermoscopy also has extensive applications beyond the diagnosis of pigmented lesions including use in keratinocyte carcinomas, infectious and inflammatory lesions, and disorders of the hair and nails.”

The study, which aimed to identify learning constructs for resident physician-level dermoscopy proficiency, used a two-phase modified Delphi survey to identify expert consensus of common dermatologic diagnoses with identifiable dermoscopic features, associated dermoscopic features for each diagnosis and representative teaching images for each figure. A panel of 26 pigmented lesion and dermoscopy experts received and voted on the survey diagnoses.

The panelists reached final consensus for 32 of 52 diagnoses, with 15 nonmelanocytic, six benign melanocytic, four melanoma and seven “special sites or other.”

A total of 142 dermoscopic features were voted on, with 116 reaching final consensus, and 442 illustrative teaching images were voted on, with 378 reaching final consensus.

Consensus was more likely to be reached on diagnoses relating to cutaneous malignant abnormality, actinic keratoses, squamous cell carcinoma, basal cell carcinoma and melanoma, whereas it was less likely to be reached on uncommon malignant abnormalities and benign inflammatory lesions.

“This is consistent with narrative feedback that, although dermoscopy has wide applications across a variety of malignant diseases, nonmalignant, infectious and inflammatory disorders, some of these are outside of the scope of day-to-day practice, and resident physician-level proficiency should prioritize the recognition of malignant disease or features suggesting need for biopsy,” the authors wrote.

The importance of dermoscopy training and education is highlighted in this study, and while there are resources available, most are not included in resident education programs.

“The expert-validated set of dermoscopic diagnoses, features and images included in this study has significant potential as a teaching curricula for dermatology resident education,” the authors wrote. “We hope that improved education during dermatology residency will translate into improved patient care during and after residency.”