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Family physicians may find dermoscopy tool useful

The Triage Amalgamated Dermoscopic Algorithm helped some family physicians, including those with no prior dermoscopy training, assess whether a skin lesion warranted further examination, according to research published in the Journal of the American Board of Family Medicine.

“In primary care settings, the clinical assessment of concerning lesions requires the ability to determine whether a biopsy or further evaluation by a specialist is warranted,” T. Rogers, MFA, of the department of medicine at Memorial Sloan Kettering Cancer Center, New York, and colleagues wrote. “However, [primary care physicians (PCPs)] often lack confidence in their abilities to recognize skin cancer. The dearth of dermatologic education in medical school curricula and family medicine residencies underscores the need for providing PCPs with better tools and training for the management of cutaneous lesions.”

According to researchers, Triage Amalgamated Dermoscopic Algorithm (TADA) uses architectural disorder, such as asymmetric distribution of colors and/or structures, as well as the presence of vessels, ulcer, negative network, polarizing white structures, gray or blue-black color or starbursts, as criteria to refer a patient to a specialist or undergo a biopsy. The study included 120 attendees of a 3-day course on dermoscopy. The participants, including 64 dermatologists and 41 primary care physicians — took part in the study, which occurred on the second day of a 3-day course on dermoscopy. After 1 day of dermoscopy training, they were given a tutorial on identifying malignant and benign skin lesion features using TADA. Forty-three percent of all participants had no previous dermoscopy training. Participants also took tests and tried to identify lesions based on what they had learned, with each assessing up to 50 lesions.

Researchers reported that TADA’s sensitivity for malignant skin lesions was 94.8% (95% CI, 93.9-95.5); specificity was 72.3% (95% CI, 70.5-74). Participants who had no dermoscopy training prior to the course identified about 74% of benign lesions correctly. Prior dermoscopy training and experience were not associated with specificity or diagnostic sensitivity. Dermatologists had higher specificity than those who were not (79% vs. 72%), but specialty was not associated with improved sensitivity.

“The results of this pilot study suggest that TADA can help inexperienced users who are motivated to learn dermoscopy detect both pigmented and nonpigmented skin cancers with very high sensitivities and specificities,” Rogers and colleagues wrote, adding larger, more diverse studies could determine TADA’s usefulness for all PCPs. – by Janel Miller