• 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.


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