Three-Point Checklist Dermoscopy for Melanoma Screening: Experience in Medical Students New to Dermatology

Three-Point Checklist Dermoscopy for Melanoma Screening: Experience in Medical Students New to Dermatology

Authors

  • Aldo Ibani Escuela de Medicina, Departamento de Dermatología, Universidad de Valparaíso, Viña del Mar, Chile.
  • Diego Aragón-Caqueo Escuela de Medicina, Universidad de Tarapacá, Arica, Chile
  • Monserrat Naveiro Escuela de Medicina, Universidad de Valparaíso, Viña del Mar, Chile.
  • Felipe Sánchez Escuela de Medicina, Universidad de Valparaíso, Viña del Mar, Chile.
  • Daniela Ríos Escuela de Medicina, Universidad de Valparaíso, Viña del Mar, Chile.
  • Javiera Medina Escuela de Medicina, Universidad de Valparaíso, Viña del Mar, Chile.
  • Antonio Guglielmetti Escuela de Medicina, Departamento de Dermatología, Universidad de Valparaíso, Viña del Mar, Chile.

Keywords:

Dermoscopy, Medical Education, Primary Care, Skin Cancer, Pattern Recognition

Abstract

Introduction: Melanoma early detection and optimal referral to the specialist, starts in primary care. The medical formation is usually deficient in training general physicians in early detection and risk management for most skin malignancies. A three-point dermoscopy checklist is used as a screening tool for differentiating malignant and benign pigmented lesions in non-expert clinicians using dermoscopy.

Objectives: To evaluate the impact of brief medical training on the three-point dermoscopy algorithm in third-year medical students, new to dermatology, and determine the levels of sensitivity and specificity to differentiate malignant and benign pigmented lesions.

Methods: Optional dermoscopic lecture for third-year medical students, new to dermatology, in the context of general medical semiology courses, with posterior case discussion and evaluation of 50 dermoscopy cases, 25 benign and 25 malignant. Students were asked to classify malignant versus benign pathology, based on the three-point dermoscopy algorithm discussed. Sensitivity, specificity, and predictive values were calculated according to the student’s responses.

Results: 3250 responses from 65 students. Malignant pathology was misclassified as being in 154 responses, while benign pathology was misclassified as malignant in 668 responses. Sensitivity and specificity for differentiating malignant lesions were 89.70% and 61.99% respectively. Moderate interobserver agreement was found (Kappa Value 0.50 [CI 0.47-0.54]).

Conclusion: When evaluating melanocytic lesions, the focus of the primary healthcare and general medical formation should emphasize the correct determination of malignant or benign pathology. Teaching the three-point dermoscopy rule to medical students, new to dermatology, yields satisfactory levels of sensitivity and specificity, comparable to general physicians.

References

Siegel RL, Miller KD, Wagle NS, Jemal A. Cancer statistics, 2023. CA Cancer J Clin. 2023;73(1):17-48. doi:10.3322/caac.21763.

Rastrelli M, Tropea S, Rossi CR, Alaibac M. Melanoma: epidemiology, risk factors, pathogenesis, diagnosis and classification. In Vivo. 2014;28(6):1005-1011.

Friedman RJ, Rigel DS, Kopf AW. Early detection of malignant melanoma: the role of physician examination and self-examination of the skin. CA Cancer J Clin. 1985;35:130-1513921200

Kittler H. Evolution of the Clinical, Dermoscopic and Pathologic Diagnosis of Melanoma. Dermatol Pract Concept. 2021;11(Suppl 1):e2021163S. doi:10.5826/dpc.11S1a163S.

Bolcato V, Michelerio A. Dermoscopy for Cutaneous Melanoma: under the eye of both the dermatologist and the legal doctor. Dermatol Pract Concept. 2022;12(03):e2022100. DOI: https://doi.org/10.5826/dpc.1203a100.

Wang SQ, Dusza SW, Scope A, Braun RP, Kopf AW, Marghoob AA. Differences in dermoscopic images from nonpolarized dermoscope and polarized dermoscope influence the diagnostic accuracy and confidence level: a pilot study. Dermatol Surg. 2008;34(10):1389-1395.

Kato J, Horimoto K, Sato S, Minowa T, Uhara H. Dermoscopy of Melanoma and Non-melanoma Skin Cancers. Front Med (Lausanne). 2019;6:180. doi:10.3389/fmed.2019.00180.

Soyer HP, Argenziano G, Zalaudek I, Corona R, Sera F, Talamini R, et al. Three-point checklist of dermoscopy. A new screening method for early detection of melanoma. Dermatology. 2004;208(1):27–31.

Argenziano G, Puig S, Zalaudek I, Sera F, Corona R, Alsina M, et al. Dermoscopy improves accuracy of primary care physicians to triage lesions suggestive of skin cancer. J Clin Oncol. 2006 Apr 20;24(12):1877–82.

Gatica JL, Aedo Inostroza G, Vezna M, Loubies R, Fuenzalida H, et al. Teledermatology in Chile: Implementation of a Single National System. J Clin Exp Dermatol Res. 2022; 13:605. DOI: 10.35248/2155- 9554.22.13.605.

Aragón-Caqueo D, Arceu M, Aragón-Caqueo G, Zamora K, Tom D, Gatica JL. Teledermatología en Chile: experiencia de su implementación temprana. Piel. 2022;37(1):1–6. doi: https://doi.org/10.1016/j.piel.2020.12.009.

Gatica JL, Bertoló S, Morales E, Espinoza M, Contreras C. Teledermatología en Chile, un aporte a la atención primaria de salud. Piel. 2015, 30, 148–54. doi: https://doi.org/10.1016/j.piel.2014.07.007.

Aragón-Caqueo D, Arceu Ojeda M, Aragón-Caqueo G, Zamora Aragón K, Tom Montalva D, Gatica Monsalve JL. Comparación del tiempo de espera de atención dermatológica mediante el uso de teledermatología y derivación presencial. Piel. 2020 Apr;35(4):220–4. doi: https://doi.org/10.1016/j.piel.2019.07.001

Compres E, Holzem K, Ibler E, Bierman JA, Rademaker AW, Kundu R V. A Brief Dermatology Curriculum in Skin Cancer Detection and Prevention to Improve Medical Student Knowledge and Confidence. MedEdPORTAL J Teach Learn Resour. 2020;16:11049. https://doi.org/10.15766/mep_2374-8265.11049.

Soyer PH, Argenziano G, Hofmann-Wellenhof Rm Zaaudek I. Dermoscopy: The Essentials. 3rd ed. Edinburgh: Saunders; 2015.

Fleiss JL. Measuring nominal scale agreement among many raters. Psychol Bull. 1971; 76:378–82.

Fleiss JL. Statistical Methods for Rates and Proportions. New York: John Wiley & Sons 1981; 212–36.

Argenziano G, Giacomel J, Abramavicus A, et al. Improving triage and management of patients with skin cancer: challenges and considerations for the future. Expert Rev Anticancer Ther. 2012;12(5):609-621. doi:10.1586/era.12.38

Koelink CJ, Kollen BJ, Groenhof F, van der Meer K, van der Heide WK. Skin lesions suspected of malignancy: an increasing burden on general practice. BMC Fam Pract. 2014;15:29. doi:10.1186/1471-2296-15-29

Brancaccio G, Russo T, Lallas A, Moscarella E, Agozzino M, Argenziano G. Melanoma: clinical and dermoscopic diagnosis. G Ital Dermatol Venereol. 2017;152(3):213-223. doi:10.23736/S0392-0488.17.05571-7

American Academy of Family Physicians (AAFP). Recommended Curriculum Guidelines for Family Medicine Residents: Conditions of the Skin. AAFP. 2021; Reprint No. 271: 1-6. https://www.aafp.org/students-residents/residency-program-directors/curriculum-guidelines.html

Posada EL, Lauck KC, Tran T, Krause KJ, Nelson KC. Educational Interventions to Support Primary Care Provider Performance of Diagnostic Skin Cancer Examinations: A Systematic Literature Review. J Cancer Educ. 2022;37(6):1579-1588. doi:10.1007/s13187-021-02118-8

Tran T, Ternov NK, Weber J, et al. Theory-Based Approaches to Support Dermoscopic Image Interpretation Education: A Review of the Literature. Dermatol Pract Concept. 2022;12(4):e2022188. doi:10.5826/dpc.1204a188.

Gronchi G, Giovannelli F. Dual process theory of thought and de- fault mode network: a possible neural foundation of fast thinking. Front Psychol. 2018;9:1237. DOI: 10.3389/fpsyg.2018.01237.

Norman G, Young M, Brooks L. Non-analytical models of clinical reasoning: the role of experience. Med Educ. 2007;41(12): 1140-1145. DOI: 10.1111/j.1365-2923.2007.02914.x.

Gatica JL, Aragón-Caqueo D, Aedo G, Fuenzalida H, Loubies R, Aedo S, Carrasco MF, Sabando V, Cunill C, Letelier MJ. Teledermatology Evaluation and Feedback Systems: A Tool for Improving Care. Healthcare. 2023; 11(11):1626. https://doi.org/10.3390/healthcare11111626.

Duniphin DD. Limited Access to Dermatology Specialty Care: Barriers and Teledermatology. Dermatol Pract Concept. 2023;13(1):e2023031. doi:10.5826/dpc.1301a31.

Liebman TN, Goulart JM, Soriano R, et al. Effect of dermoscopy education on the ability of medical students to detect skin cancer. Arch Dermatol. 2012;148(9):1016-1022. doi:10.1001/archdermatol.2012.509

Tschandl P, Kittler H, Schmid K, Zalaudek I, Argenziano G. Teaching dermatoscopy of pigmented skin tumours to novices: Comparison of analytic vs. heuristic approach. J Eur Acad Dermatology Venereol. 2015;29(6):1198–204.

Zalaudek I, Argenziano G, Soyer HP, et al. Three-point checklist of dermoscopy: an open internet study. Br J Dermatol. 2006;154(3):431-437. doi:10.1111/j.1365-2133.2005.06983.x

Harkemanne E, Legrand C, Sawadogo K, et al. Evaluation of primary care physicians' competence in selective skin tumour triage after short versus long dermoscopy training: a randomized non-inferiority trial. J Eur Acad Dermatol Venereol. 2023;10.1111/jdv.19087. doi:10.1111/jdv.19087.

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Published

2024-07-31

How to Cite

1.
Three-Point Checklist Dermoscopy for Melanoma Screening: Experience in Medical Students New to Dermatology. Dermatol Pract Concept [Internet]. 2024 Jul. 31 [cited 2024 Dec. 5];14(3):e2024211. Available from: https://www.dpcj.org/index.php/dpc/article/view/3590

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