Dermoscopy in general practice

: Insights for clinical use and training

Abstract

The incidence of skin cancers of all types continue to rise across many highly developed countries including the UK and Ireland. This includes melanoma, the most dangerous form of skin cancer due to its propensity for early metastasis. Key to its successful management is early recognition and excision. Most patients with new or changing skin lesions first attend their general practitioner (GP) for an assessment. However the accuracy of skin lesion assessments in primary care is limited by the problem that many early melanomas can appear benign to the naked eye, and many benign skin lesions can mimic melanoma.

Dermoscopy is an examination tool that can improve the accuracy of skin lesion assessments. It uses a magnification lens and internal light source to facilitate a more detailed skin examination than is possible with the naked eye. However to date it has only been adopted in a limited way in primary care, and training in it is required if improved accuracy of skin assessments is to be achieved. This thesis examines dermoscopy use and training among GPs.

An initial scoping literature review of dermoscopy use among GPs identified 7 articles published since 2007. They showed that dermoscopy is used by a small minority of GPs, and that equipment costs and training requirements are commonly perceived barriers to its use. A second scoping literature review of GP training in dermoscopy identified 16 articles published since 2000. They showed that many GPs practise dermoscopy without training, but that training programmes have been developed for GPs, many of which improve their skills in skin lesion assessment.

A qualitative study was subsequently carried out to assess factors influencing GPs’ use of dermoscopy. Semi-structured interviews were conducted with a purposive sample of GPs: established dermoscopy users, new adopters of dermoscopy and dermoscopy non-users. Twelve interviews were conducted and data analysed using a Thematic Analysis. Three major themes were identified from the data: GPs’ capability to use dermoscopy, including the need for training and experience; GPs’ perceptions of its clinical impact; and the acceptability of the tool within primary care.

As a whole, the findings of this research highlight the potentially favourable clinical impact of widening patient access to dermoscopy in primary care, as well as many of the issues that impact on dermoscopy use in general practice. Foremost among these is the need for adequate and effective training. This evidence supports ongoing efforts to define and facilitate appropriate use of dermoscopy among GPs.

Date of Award	Dec 2021
Original language	English
Awarding Institution	Queen's University Belfast
Sponsors	Northern Ireland Public Health Agency
Supervisor	Nigel Hart (Supervisor) & Finbar McGrady (Supervisor)