Dermoscopy would make significant improvement in the fight against skin cancer. A study showed that the application of three basic criteria of dermoscopy gives more clarity for referring patients to a skin specialist. // This was shown in a study promoted by IDIBAPS-Hospital Clinic, in collaboration with several Catalan and Italian Primary Care Centres. This strategy they hope could relieve the demand of dermatology consultations and reduces dramatically the number of false negatives.
The primary care physicians (PCP) care for basic health problems of the people and refer them to specialists, who form the second level of health care. The PCPs, there by help in identifying pathologies and act as a connection in the network for doctors. The studies show that dermatology is one of the public health areas where the ability of PCPs could contribute with more benefits. A study promoted by researchers, shows that dermoscopy could increase sensitivity in 25% for the detection of malignant lesions. The study showed that three simple dermoscopy classification criteria would help PCPs make decisions. The team said that previous research works emphasized the benefits of dermoscopy, but its real usefulness had never been demonstrated in the framework of a real health system until now. The results will be published on 21st in the Journal of Clinical Oncology. Several researchers of the IDIBAPS Genetic Factors and Treatment of Malignant Melanoma Group will endorse the article.
About 73 physicians were chosen to take part in the study. They came from the Primary Care Centre CAP Les Corts and from the CAPSE, centres linked to Hospital Clinic de Barcelona, and from medical centres in Naples (Italy). All of them were trained in a four-hour dermoscopy course and afterwards were randomly divided into two study groups. One group was given a dermoscope to work with and the second group was asked to work without a dermoscope. The dermoscope is a small magnifier with
an illumination system, which permits the physician to visualize the morphological details of a skin lesion. The physicians were given three criteria given in the course that would help to detect possible malignant tumours were. They were asymmetry of colour or structure, presence of a net of thick lines with irregular distribution and detection of white and/or blue structures. They were also advised that if two of these criteria are met, the examined lesion could be considered potentially malignant and the patient must be referred to a specialist.
During the next 6 months, the PCPs visited 3,271 patients of skin pathologies. A specialised dermatologist supervised all of them. The studies found that PCPs not applying dermoscopy techniques tended to refer more patients to the specialist, and they also overlooked a higher number of potentially malignant lesions. Whereas the physician, using dermoscopy were able to detect more sensitively these lesions. Increasing the percentage from 54.1% to 79.2%. It was also studied that if the physician used dermoscopy, and the specificity was maintained. The percent of false negatives was reduced to less than a half, reaching 2%.
The research concluded that, with the use of dermoscopy among PCPs, along with training in the three criteria to help to classify lesions, could mean a reduction of the congestion of specialized offices and a significant improvement in the fight against skin cancer.
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