Dermoscopy for melanoma detection and triage in primary care: a systematic review.
Van Melle, Marije
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Jones, O., Jurascheck, L., Van Melle, M., Hickman, S., Burrows, N., Hall, P., Emery, J., & et al. (2019). Dermoscopy for melanoma detection and triage in primary care: a systematic review.. BMJ open, 9 (8), e027529. https://doi.org/10.1136/bmjopen-2018-027529
Objective: Most skin lesions first present in primary care where distinguishing rare melanomas from benign lesions can be challenging. Dermoscopy improves diagnostic accuracy among specialists and is promoted for use by primary care physicians (PCPs). However, when used by untrained clinicians, accuracy may be no better than visual inspection. This study aimed to undertake a systematic review of literature reporting use of dermoscopy to triage suspicious skin lesions in primary care settings, and challenges for implementation. Design: A systematic literature review and narrative synthesis. Data Sources: We searched Medline, Cochrane, EMBASE, CINAHL and SCOPUS bibliographic databases from 1st January 1990 to 31st December 2017, without language restrictions. Inclusion criteria: Studies including assessment of dermoscopy accuracy, acceptability to patients and PCPs, training requirements, and cost-effectiveness of dermoscopy modes in primary care, including trials, diagnostic accuracy and acceptability studies. Results: 23 studies met the review criteria, representing 49,769 lesions and 3,708 PCPs, all from high-income countries. There was a paucity of studies set truly in primary care and the outcomes measured were diverse. The heterogeneity therefore made meta-analysis unfeasible; the data were synthesised through narrative review. Dermoscopy, with appropriate training, was associated with improved diagnostic accuracy for melanoma and benign lesions, and reduced unnecessary excisions and referrals. Teledermoscopy-based referral systems improved triage accuracy. Only 3 studies examined cost-effectiveness, hence there was insufficient evidence to draw conclusions. Costs, training and time requirements were considered important implementation barriers. Patient satisfaction was seldom assessed. Computer-aided dermoscopy and other technological advances have not yet been tested in primary care. Conclusions: Dermoscopy could help PCPs triage suspicious lesions for biopsy, urgent referral or reassurance. However, it will be important to establish further evidence on minimum for training to reach competence, as well as the cost-effectiveness and patient acceptability of implementing dermoscopy in primary care.
Humans, Melanoma, Skin Neoplasms, Dermoscopy, Biopsy, Reproducibility of Results, Triage, Primary Health Care
Cancer Research UK (23385)
Embargo Lift Date
External DOI: https://doi.org/10.1136/bmjopen-2018-027529
This record's URL: https://www.repository.cam.ac.uk/handle/1810/294536
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