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General practice / Family practice
Research
Dermoscopy for melanoma detection and triage in primary care: a systematic review
  1. OT Jones1,
  2. LC Jurascheck2,
  3. MA van Melle1,
  4. S Hickman3,
  5. NP Burrows4,
  6. PN Hall5,
  7. J Emery1,6,
  8. FM Walter1,6
  1. 1 Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
  2. 2 University of Cambridge School of Clinical Medicine, Cambridge, UK
  3. 3 Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, UK
  4. 4 Addenbrooke's Hospital Department of Dermatology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
  5. 5 Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
  6. 6 General Practice and Primary Care Academic Centre, University of Melbourne, Carlton, Victoria, Australia
  1. Correspondence to Dr OT Jones; otj24{at}medschl.cam.ac.uk

Abstract

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 Central, EMBASE, Cumulative Index to Nursing and Allied Health Literature, and SCOPUS bibliographic databases from 1 January 1990 to 31 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 3708 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 three 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 training requirements to reach competence, as well as the cost-effectiveness and patient acceptability of implementing dermoscopy in primary care.

Trial registration number CRD42018091395.

  • dermoscopy
  • melanoma
  • primary care
  • systematic review
  • skin cancer

This is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license, which permits others to copy, redistribute, remix, transform and build upon this work for any purpose, provided the original work is properly cited, a link to the licence is given, and indication of whether changes were made. See: https://creativecommons.org/licenses/by/4.0/.

https://doi.org/10.1136/bmjopen-2018-027529

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    Footnotes

    • Contributors OJ developed the protocol, completed the search, screened the articles for inclusion, extracted the data, synthesised the findings, interpreted the results and drafted the manuscript. LJ screened the articles for inclusion, extracted the data and critically revised the manuscript. MvM screened the articles for inclusion, extracted the data and critically revised the manuscript. SH screened the articles for inclusion and critically revised the manuscript. NB developed the protocol and critically revised the manuscript. PH developed the protocol and critically revised the manuscript. JE developed the protocol, interpreted the results and critically revised the manuscript. FMW developed the protocol, synthesised the findings, interpreted the results and critically revised the manuscript. All authors approved the final version.

    • Funding This research arises from the CanTest Collaborative, which is funded by Cancer Research UK (C8640/A23385), of which FW is Director and JE is Associate Director. This work was also supported by FMW’s Clinician Scientist Award (RG 68235) from the National Institute for Health Research (NIHR). The views expressed in this publication are those of the authors and not necessarily those of the National Health Service, the NIHR or the Department of Health. The funding sources had no role in the study design, data collection, data analysis, data interpretation, writing of the report or in the decision to submit for publication.

    • Competing interests PH is Clinical Advisor for Skin Cancer to Check4Cancer, a company that offers teledermatoscopic analysis of pigmented skin lesions (https://www.check4cancer.com), and is a medical advisor to MedX, the Canadian company with the IP for the SIAscope (https://medxhealth.com/default.aspx).

    • Patient consent for publication Not required.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data availability statement Data are available upon reasonable request.