Response: Re: Expert Consensus Statement on Proficiency Standards for Dermoscopy Education in Primary Care

To the Editor: We agree with Dr. Blum that mastery level dermoscopy training is most appropriate for family physicians who wish to make dermatology a focus of their clinical practice. We also agree with the American Academy of family physicians, which has published recommendations that all Family Medicine residents receive dermoscopy training during residency.¹ Thus, our work² aimed to provide a guide for foundational dermoscopy training. Our panel included 14 family physicians, including both those who focus on dermatology and family physicians who practice the full spectrum of primary care without a skin focus. Although Dr. Blum has concerns that our inclusion of 14 family physicians is insufficient to generate a robust and meaningful consensus statement, we wish to share that we approached numerous physicians and found the 14 family physicians who committed to our project to be highly engaged and willing to rigorously reflect the practice of themselves and their peers.

Our inclusion of advanced practice practitioners (APPs) such as physician assistants and nurse practitioners was in no way inadvertent, but a reflection of the current diversity of practitioners caring for patients, particularly in underserved areas. If we deliberately exclude APPs in our skin cancer education and prevention efforts, we do not reflect the “real world” care environment.

Dr. Blum suggests that we deliberately dodged the question of whether teledermatology could better reduce geographic disparities in skin cancer detection. We intentionally did not include that topic as teledermatology and asynchronous electronic visits (eVisits or eConsults) are well established in dermatology and many of these programs now include dermoscopy (teledermoscopy)^3⇓–5 Furthermore, there are now published guidelines for the use of dermoscopy in telemedicine.⁶

Teledermoscopy not only allows for improved visualization of skin tumors, but also serves as a potential telementoring opportunity for primary care physicians aiming to improve their dermoscopy skills. These virtual platforms allow for the transfer of knowledge to patients and create a collaborative learning environment that benefits patients and physicians. We have both participated in telementoring efforts with family physician colleagues^7,8 who wish to move beyond a list of common dermatologic diagnoses and add dermoscopy to their clinical practice. As medical educators and melanoma prevention researchers, we appreciate the value in consensus-driven agreement on which dermoscopic diagnoses are most appropriate when teaching foundational skin cancer detection skills with our primary care colleagues.

Lastly, it is not the family physician who will be losing out if the dermatoscope is not in their clinical toolbox– the patient with a concerning skin growth who took time off from work to see his Family Physician is the 1 who misses out on timely care. Dermoscopy is not a tool exclusively used by dermatologists.⁹ Physicians are lifelong learners, and we must evolve and embrace technology—dermoscopy—that aids our physical examination skills, improves skin cancer detection, and reduces unnecessary biopsies.¹⁰

With respect,