ORIGINAL RESEARCH
Tiffaney Tran, BS; Peggy R. Cyr, MD, MS; Alex Verdieck, MD; Miranda D. Lu, MD; Hadjh T. Ahrns, MD; Elizabeth G. Berry, MD; William Bowen, MD; Ralph P. Braun, MD; Joshua M. Cusick-Lewis, MD; Hung Q. Doan, MD, PhD; Valerie L. Donohue, MD; Deborah R. Erlich, MD, MMedEd; Laura K. Ferris, MD, PhD; Evelyne Harkemanne, MD; Rebecca I. Hartman, MD, MPH; James Holt, MD; Natalia Jaimes, MD; Timothy A. Joslin, MD; Zhyldyz Kabaeva, MD; Tracey N. Liebman, MD; Joanna Ludzik, MD, PhD; Ashfaq A. Marghoob, MD; Isac Simpson, DO; Jennifer A. Stein, MD, PhD; Daniel L. Stulberg, MD; Isabelle Tromme, MD, PhD; Matthew J. Turnquist, MD; Richard P. Usatine, MD; Alison M. Walker, MD; Bryan L. Walker, MD; Robert F. West, MD, MMed; Megan L. Wilson, MD; Alexander Witkowski, MD, PhD; Dominic J. Wu, MD; Elizabeth V. Seiverling, MD; Kelly C. Nelson, MD
Corresponding Author: Kelly C. Nelson, MD; Department of Dermatology - The University of Texas MD Anderson Cancer Center.
Email: kcnelson1@mdanderson.org
DOI: 10.3122/jabfm.2022.220143R1
Keywords: Continuing Medical Education, Delphi Method, Dermoscopy, Expert Opinion, Focus Groups, General Practitioners, Melanoma, Primary Care Physicians, Primary Health Care, Skin Cancer
Dates: Submitted: 04-08-2022; Revised: 08-16-2022; Accepted: 08-17-2022
Final Publication: | HTML | | PDF |
BACKGROUND: Primary care providers (PCPs) frequently address dermatologic concerns and perform skin examinations during clinical encounters. For PCPs who evaluate concerning skin lesions, dermoscopy (a noninvasive skin visualization technique) has been shown to increase the sensitivity for skin cancer diagnosis compared to unassisted clinical examinations. Prior to this study, no formal consensus existed on the fundamental knowledge and skills that PCPs should have with respect to dermoscopy for skin cancer detection. The objective of this study was to develop an expert consensus statement on proficiency standards for PCPs learning or using dermoscopy.
METHODS: A two-phase modified Delphi method was used to develop two proficiency standards: foundational and intermediate. In first phase, a smaller focus group of PCPs and dermatologists generated a list of dermoscopic diagnoses and associated features. In the second phase, a larger panel evaluated the proposed list of diagnoses and determined whether each was reflective of a foundational proficiency, intermediate proficiency, or neither. Panelists also approved a list of characteristic features for each diagnosis. Of the 40 experts invited to join the panel, 35 (87.5%, 21 PCPs and 14 dermatologists) consented to participate and completed the initial round.
RESULTS: Of the 35 initial panelists, five PCPs were lost to follow-up or withdrew, and 30 (85.7%) completed the fifth and last round. The final consensus-based list contained 39 dermoscopic diagnoses (13 “foundational” and 26 “intermediate”) and their associated features.
CONCLUSIONS: This consensus statement will inform the development of PCP-targeted dermoscopy training initiatives designed to support early skin cancer detection.