Primary care physicians who took an online training course about skin cancer detection significantly improved their skill to properly diagnose and manage benign and malignant lesions, according to a national study from Henry Ford Hospital in Detroit.

The physicians’ enhanced skill level also led to a reduction in unnecessary referrals to dermatology specialists.

The INFORMED study is believed to be the first of its kind to track physician practice patterns as an outcome of a skin cancer detection training course. INFORMED stands for INternet curriculum FOR Melanoma Early Detection.

Key findings of 54 physicians who took the course:

  Scores for diagnosing and managing all skin cancer lesions increased 10 percent.
  Scores for diagnosing benign lesions increased 14 percent.
  Patient referrals for suspicious lesions or new visits to a dermatology specialist declined as the result of improved detection by primary care physicians.
  Physicians still retained their improved skill level six months later.

The findings are published online in the November/December issue of the Journal of the American Board of Family Medicine at http://url.health.am/1311/

“We all know the demands on a physician’s time. But this online course shows that we can empower primary care physicians to know when they themselves can take care of some of these patients and have the confidence in doing so, and not drive up the cost of utilization with unnecessary referrals to a dermatologist,” says Melody Eide, M.D., a Henry Ford dermatologist and the study’s lead author.

Each year, there are more new cases of skin cancer than the combined incidence of breast, prostate, lung and colon cancers, according to the Skin Cancer Foundation. Treatment of nonmelanoma skin cancers has increased by nearly 77 percent between 1992 and 2006. Meanwhile, incidence rates of melanoma - the most serious form of skin cancer - have been increasing for at least 30 years. It is estimated that one in 50 Americans will develop melanoma by 2015.

Given these disconcerting trends, researchers sought to evaluate whether primary care physicians (PCP) could diagnose skin cancer if provided targeted, specific education. PCPs, after all, see more patients than any other physician group. Fewer than 30 percent of primary care residents receive training for performing a skin examination during their medical training.

“Improving PCPs skills at diagnosing and managing skin lesions is an important way to improve patient care because patients frequently bring skin complaints to their family doctor,” Dr. Eide says.

The web-based course http://www.skinsight.com/info/for_professionals/skin-cancer-detection-informed/skin-cancer-education  covered the three most common skin cancers - basal cell carcinoma, squamous cell carcinoma and melanoma, and featured 450 clinical images of lesions.  The participants chose from two web options - traditional textbook format and case-based format, which took about two to three hours to complete. The case-based format featured nine case studies with interactive self-assessment tests and immediate feedback.

Before taking the course in 2011, participants took a pretest of 25 images of skin lesions in which they had to choose a diagnosis and course of action - reassure or refer. Participants were assessed a post-test immediately after completing the course, then repeated six months later.

“Their post-test scores were much higher than their pre-test scores,” Dr. Eide says. “The scores suggest that prior to taking the course, the participants had the most difficulty distinguishing between benign and malignant skin lesions. But taking the course improved their ability to do so.”

The INFORMED study involved nine U.S. health care institutions: Henry Ford Hospital, Kaiser Permanente, Harvard Medical School, Harvard Pilgrim Health Care Institute, Harvard School of Public Health, Memorial Sloan-Kettering Cancer Center, Veterans Affairs Medical Center, Rhode Island Hospital and Brown University.

The study was funded by the Melanoma Research Alliance.

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David Olejarz
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