Nadeen Gonna1, Tiffaney Tran2, Roland L Bassett3, David P Farris4, Kelly C Nelson5. 1. John P. and Kathrine G. McGovern Medical School, Houston, TX, USA. 2. Department of Dermatology, The University of Texas MD Anderson Cancer Center, 1400 Pressler St, Unit 1452, Houston, TX, 77030, USA. 3. Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA. 4. Research Medical Library, The University of Texas MD Anderson Cancer Center, Houston, TX, USA. 5. Department of Dermatology, The University of Texas MD Anderson Cancer Center, 1400 Pressler St, Unit 1452, Houston, TX, 77030, USA. kcnelson1@mdanderson.org.
Abstract
BACKGROUND: In areas without convenient access to dermatology care, primary care providers (PCPs) serve as an important patient resource for early skin cancer detection. To determine the most effective strategy for skin cancer detection training in PCPs, we conducted a systematic review of educational interventions and performed a meta-analysis on sensitivity and specificity outcomes in PCPs. OBJECTIVES: To summarize data on skin cancer sensitivity and specificity outcomes for PCP-targeted training programs and diagnostic algorithms. Our PCP cohort included practicing physicians, trainee physicians, and advanced practice practitioners. METHODS: A literature search was performed in MEDLINE, Embase, Web of Science, and the Cochrane Library for relevant English-language articles published worldwide from 2000 onward. Results were screened for eligibility, and overlapping datasets were reconciled. Data extracted included the educational intervention, diagnostic algorithm, and outcomes of interest (sensitivity and specificity). Outcomes were pooled across interventions that taught the same diagnostic algorithm. A bivariate model was fit to compare different interventions/algorithms. This review followed the PRISMA guidelines. RESULTS: In total, 21 articles were included in this review, encompassing over 58,610 assessments of skin lesions by about 1529 participants worldwide. Training programs that implemented the triage-amalgamated dermoscopic algorithm (TADA) demonstrated high pooled sensitivity (91.7%) and high pooled specificity (81.4%) among PCPs. CONCLUSIONS AND RELEVANCE: Overall, this systematic review and meta-analysis showed that dermoscopy training in PCPs was generally associated with gains in skin cancer sensitivity without loss of specificity. Clinically, this correlates with fewer skin cancers overlooked by PCPs and fewer excisions of benign lesions.
BACKGROUND: In areas without convenient access to dermatology care, primary care providers (PCPs) serve as an important patient resource for early skin cancer detection. To determine the most effective strategy for skin cancer detection training in PCPs, we conducted a systematic review of educational interventions and performed a meta-analysis on sensitivity and specificity outcomes in PCPs. OBJECTIVES: To summarize data on skin cancer sensitivity and specificity outcomes for PCP-targeted training programs and diagnostic algorithms. Our PCP cohort included practicing physicians, trainee physicians, and advanced practice practitioners. METHODS: A literature search was performed in MEDLINE, Embase, Web of Science, and the Cochrane Library for relevant English-language articles published worldwide from 2000 onward. Results were screened for eligibility, and overlapping datasets were reconciled. Data extracted included the educational intervention, diagnostic algorithm, and outcomes of interest (sensitivity and specificity). Outcomes were pooled across interventions that taught the same diagnostic algorithm. A bivariate model was fit to compare different interventions/algorithms. This review followed the PRISMA guidelines. RESULTS: In total, 21 articles were included in this review, encompassing over 58,610 assessments of skin lesions by about 1529 participants worldwide. Training programs that implemented the triage-amalgamated dermoscopic algorithm (TADA) demonstrated high pooled sensitivity (91.7%) and high pooled specificity (81.4%) among PCPs. CONCLUSIONS AND RELEVANCE: Overall, this systematic review and meta-analysis showed that dermoscopy training in PCPs was generally associated with gains in skin cancer sensitivity without loss of specificity. Clinically, this correlates with fewer skin cancers overlooked by PCPs and fewer excisions of benign lesions.
Keywords:
Advanced practice practitioner; Early detection; Melanoma; Meta-analysis; Nurse practitioner; Physician assistant; Primary care provider; Secondary prevention; Sensitivity; Skin cancer; Skin cancer detection; Skin cancer diagnosis; Skin cancer education; Specificity; Systematic literature review
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