• Ivan Bristow

Can dermoscopy training improve a podiatrist's lesion recognition skills?


I have written a few blogs over the last few years on the topic of dermoscopy and dermatoscopes, highlighting how the technique can really improve a practitioner’s ability to recognise a suspicious lesion, particularly melanoma [1]. Up until now, there have been various studies and discussion papers demonstrating its utility amongst various groups including dermatologists, general practitioners and hospital doctors [2-15]. The general consensus being it improves one’s recognition skills with few disadvantages to its use. Most recently, podiatrists are beginning to learn the technique through various courses that are available in the UK and other countries, however, there has been little research published assessing how effective it can be for this professional group.






A forthcoming study has been published in the Australian Journal of Dermatology which suggests that dermoscopy training for podiatrists can be effective in improving recognition skills for a particularly aggressive pedal malignancy – the acral lentiginous melanoma (ALM)[16]. The ALM is a sub-type of melanoma that affects the palms, soles, and nail beds. Unlike other types of melanoma, it may arise all skin types including darker skin [17]. The prognosis for this type of lesion is often poorer due to its remote location and late presentation and diagnosis.


Consequently, any initiative to improve recognition and diagnosis has potential benefits to reduce morbidity and mortality. The study conducted in Catalonia in Spain assessed 81 podiatrists (67 female and 14 male) before and after, as they underwent a 6-hour training course introducing dermoscopy including an online learning component. The course was split into two, 3-hour sessions taught one month apart. Prior to the commencement of the course and following completion, podiatrists were tested on their recognition skills with 10 clinical cases, using the same cases for each test.


The results showed a statistically significant improvement in median test scores after the training. The rose from 5/10 to 10/10 after the educational intervention. Specifically, median scores for correctly recognising ALM rose from 3/8 (pre-test) to 7/89 (post-test). The results concur with virtually all other studies conducted on this topic showing how training positively improves one’s ability to recognise suspicious lesions. Of course, as the authors acknowledge, one must examine the study for potential sources of bias. Firstly, this is a small sample of podiatrists from one country. In addition, a small set of cases were used (n=10). It is potentially possible that because they were repeated some recall bias may have occurred influencing the outcome.


Ultimately, it would be good also to examine how the podiatrists use the technique subsequent to the training and to see how their referral patterns may have changed in the light of the training but that of course, is another piece of research that needs to be carried out. Acral melanoma is a rare but potentially life-shortening condition. There is much evidence out there to demonstrate issues with delay in diagnosis, so any measure available which can mitigate this risk is always welcome.





References


1. Argenziano G, Ferrara G, Francione S, Di Nola K, Martino A, Zalaudek I: Dermoscopy--the ultimate tool for melanoma diagnosis. Semin Cutan Med Surg 2009, 28(3):142-148.

2. Carli P, De Giorgi V, Naldi L, Dosi G: Reliability and inter-observer agreement of dermoscopic diagnosis of melanoma and melanocytic naevi. Dermoscopy Panel. Eur J Cancer Prev 1998, 7(5):397-402.

3. Chappuis P, Duru G, Marchal O, Girier P, Dalle S, Thomas L: Dermoscopy, a useful tool for general practitioners in melanoma screening: a nationwide survey. Br J Dermatol 2016, 175(4):744-750.

4. Chevolet I, Hoorens I, Janssens A, Speeckaert R, Van Geel N, Van Maele G, Vossaert K, Brochez L: A short dermoscopy training increases diagnostic performance in both inexperienced and experienced dermatologists. Australas J Dermatol 2015, 56(1):52-55.

5. De Bedout V, Williams N, Muñoz A, Londoño A, Munera M, Naranjo N, Rodriguez L, Toro A, Miao F, Koru-Sengul T et al: Skin cancer and dermoscopy training for primary care physicians: a pilot study. . Dermatol Pract Concept 2021, 11(1).

6. Errichetti E, Stinco G: Dermoscopy in General Dermatology: A Practical Overview. Dermatology and therapy 2016, 6(4):471-507.

7. Fee JA, McGrady FP, Hart ND: Dermoscopy use in UK primary care. J Eur Acad Dermatol Venereol 2019, 33(12):e465-e466.

8. Forsea AM, Tschandl P, Zalaudek I, del Marmol V, Soyer HP, Eurodermoscopy Working G, Argenziano G, Geller AC: The impact of dermoscopy on melanoma detection in the practice of dermatologists in Europe: results of a pan-European survey. J Eur Acad Dermatol Venereol 2017, 31(7):1148-1156.

9. Herschorn A: Dermoscopy for melanoma detection in family practice. Can Fam Physician 2012, 58(7):740-745.

10. Jones OT, Jurascheck LC, Utukuri M, Pannebakker MM, Emery J, Walter FM: Dermoscopy use in UK primary care: a survey of GPs with a special interest in dermatology. Journal of the European Academy of Dermatology and Venereology : JEADV 2019, 33(9):1706-1712.

11. Jones OT, Jurascheck LC, van Melle MA, Hickman S, Burrows NP, Hall PN, Emery J, Walter FM: Dermoscopy for melanoma detection and triage in primary care: a systematic review. BMJ open 2019, 9(8):e027529-e027529.

12. Koelink CJL, Vermeulen KM, Kollen BJ, de Bock GH, Dekker JH, Jonkman MF, van der Heide WK: Diagnostic accuracy and cost-effectiveness of dermoscopy in primary care: a cluster randomized clinical trial. J Eur Acad Dermatol Venereol 2014, 28(11):1442-1449.

13. Liebman TN, Goulart JM, Soriano R, et al.: Effect of dermoscopy education on the ability of medical students to detect skin cancer. Arch Dermatol 2012, 148(9):1016-1022.

14. Menzies SW, Zalaudek I: Why perform dermoscopy? The evidence for its role in the routine management of pigmented skin lesions. Arch Dermatol 2006, 142(9):1211-1212.

15. Venugopal SS, Soyer HP, Menzies SW: Results of a nationwide dermoscopy survey investigating the prevalence, advantages and disadvantages of dermoscopy use among Australian dermatologists. Australas J Dermatol 2011, 52(1):14-18.

16. Serra-Garcia L, Podlipnik S, Bedoya J, Ertekin SS, Manubens E, Carrera C, Zalacain-Vicuna AJ, Malvehy J, Puig S: Dermoscopy training course improves podiatrists' accuracy in diagnosing lesions suggestive of acral melanoma: A cross-sectional study. Australas J Dermatol 2021.

17. Bristow IR, de Berker DA, Acland KM, Turner RJ, Bowling J: Clinical guidelines for the recognition of melanoma of the foot and nail unit. J Foot Ankle Res 2010, 3(25).

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