Early Melanoma Detection in Primary Care: Clinical Recognition of Melanoma is Not Enough, One Must Also Learn the Basics
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Early Melanoma Detection in Primary Care: Clinical Recognition of Melanoma is Not Enough, One Must Also Learn the Basics Evelyne Harkemanne 1,2
&
Noémie Goublomme 3 & Kiswendsida Sawadogo 4 & Isabelle Tromme 1,5
Accepted: 9 October 2020 # American Association for Cancer Education 2020
Abstract To improve early melanoma detection, educational programs have been developed for general practitioners (GPs). This study aimed to determine whether the adjunct of teaching basic knowledge of pigmented skin lesions (PSL) to the training in melanoma diagnosis improves the GPs’ diagnostic accuracy of melanoma. An interventional prospective study was conducted over a 3month period where GPs attended a 2-h training course. The 1st session taught clinical melanoma recognition and the 2nd session instructed basic knowledge of PSL. Prior to training, after the 1st, and after the 2nd session, GPs were asked to select the malignant or benign nature of 15 clinical images associated to their clinical history. In total, 56 GPs participated in this study. The number of GPs identifying correctly ≥ 50% of the melanomas increased the most after the 1st session from 15 (26.8%; CI = (15.2; 38.4)) to 44 (78.6%; CI = (67.8; 89.3)) GPs (P < 0.001). The number of GPs correctly identifying ≥ 50% of the benign PSL only increased after completing the entire training, going from 10 (17.9%; CI = [(7.8; 27.9)) GPs to 50 (89.3%; CI = (81.2; 97.4)) GPs (P < 0.001). In this study, GPs identified benign PSL most accurately after the 2nd session. This suggested that teaching GPs the basics of PSL would especially improve their diagnostic accuracy for benign PSL, which could reduce unnecessary referrals to dermatologists. Teaching basic knowledge of PSL in addition to melanoma recognition seemed to enable GPs to triage skin lesions more effectively than when they were only trained to recognize melanoma. Keywords Continuing medical education . General practitioner . Melanoma . Early cancer detection
Introduction The last two decades, general practitioners (GPs) have been recognized to play a key role in early melanoma detection [1, 2]. In order to help GPs dealing with suspicious skin lesions of melanoma, training programs in melanoma diagnosis especially designed for GPs have been developed [3, 4].
* Evelyne Harkemanne [email protected] 1
Dermatology Department, Cliniques Universitaires Saint-Luc, Avenue Hippocrate, 10, B-1200 Brussels, Belgium
2
Institute of Experimental and Clinical Research (IREC), UCLouvain, Brussels, Belgium
3
General Practice in Centre Médical Chrysalide, Pironchamps, Belgium
4
Statistical Support Unit, King Albert II Cancer and Hematology Institute, Cliniques Universitaires Saint-Luc, Brussels, Belgium
5
King Albert II Cancer and Hematology Institute, Cliniques Universitaires Saint-Luc, Brussels, Belgium
All these training programs included training in melanoma recognition using clinical (naked eye) diagnostic tools, such as the ABCD rule [5], pattern recognition [6], and the “ugly duckling” sign [7], some
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