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Learning a novel technique to identify possible melanomas: are Australian general practitioners better than their U.K. colleagues?

Learning a novel technique to identify possible melanomas: are Australian general practitioners... Background: Spectrophotometric intracutaneous analysis (SIAscopy™) is a multispectral imaging technique that is used to identify 'suspicious' (i.e. potentially malignant) pigmented skin lesions for further investigation. The MoleMate™ system is a hand-held scanner that captures SIAscopy™ images that are then classified by the clinician using a computerized diagnostic algorithm designed for the primary health care setting. The objectives of this study were to test the effectiveness of a computer program designed to train health care workers to identify the diagnostic features of SIAscopy™ images and compare the results of a group of Australian and a group of English general practitioners (GPs). Methods: Thirty GPs recruited from the Perth (Western Australia) metropolitan area completed the training program at a workshop held in March 2008. The accuracy and speed of their pre- and post-test scores were then compared with those of a group of 18 GPs (including 10 GP registrars) who completed a similar program at two workshops held in Cambridge (U.K.) in March and April, Results: The median test score of the Australian GPs improved from 79.5% to 86.5% (median increase 5.5%; p < 0.001) while the median test score of the English GPs improved from 74.5% to 86.5% (median increase 9.5%; p < 0.001). The Australian GPs had significantly higher pre-test scores but there were no significant differences in post-test scores between the Australian and English GPs or between the GPs and GP registrars. There was no significant difference in scores between GPs with previous dermoscopy experience or dermatology training. Conclusion: Most of the SIAscopy™ features can be learnt to a reasonable degree of accuracy with this brief computer training program. Although the Australian GPs scored higher in the pre- test, both groups had similar levels of accuracy and speed in interpreting the SIAscopy™ features after completing the program. Scores were not affected by previous dermoscopy experience or dermatology training, which suggests that the MoleMate™ system is relatively easy to learn. Page 1 of 5 (page number not for citation purposes) Asia Pacific Family Medicine 2009, 8:3 http://www.apfmj.com/content/8/1/3 been shown to have a sensitivity of 82.7% (95% confi- Background In Australia, skin cancer is the most common cancer, with dence interval [CI] 70.3% – 90.6%) and specificity of melanoma being the fourth most common registrable 80.1% (95% CI 75.1% – 84.2%) for the diagnosis of cancer after prostate, colorectal, and breast cancer [1]. In melanoma [15]. Receiver-operator characteristic analysis 2003, there were 9,524 new cases of melanoma – a 14% showed that the SIAscopy™ experts achieved a diagnostic increase in incidence since 1993 – and 1,146 deaths (764 accuracy similar to that of 11 dermatologists with 9 hours males and 382 females) [1]. The risk of developing of dermoscopy training [16]. The MoleMate™ system, melanoma before the age of 75 is 1 in 24 for males and 1 which uses a diagnostic algorithm derived from patients in 34 for females [1]; melanoma is the most common can- attending primary health care clinics, has been shown to cer in the 20 to 39 year old age group [2]. have a sensitivity of 100% (95% CI 44% – 100%) and spe- cificity of 78% (95% CI 75% – 82%) for the diagnosis of Because the prognosis for melanoma is very good when melanoma [17]. For comparison, a 2001 systematic lesions are excised 'early' (97.9% 10-year survival ≤ 0.75 review of studies of unaided clinical diagnostic accuracy mm Breslow thickness) and poor when they are not (40% for melanoma found that biopsy or referral sensitivity and 10-year survival > 4 mm Breslow thickness), the National specificity were 82–100% and 70–89% for dermatologists Health and Medical Research Council has emphasized the and 70–88% and 70–87% for Primary Care Physicians importance of the early diagnosis of melanoma [3]. When (GPs) [18]. The MoleMate™ system is currently undergo- compared with dermatologists, General Practitioners ing a randomised controlled trial (RCT) in general prac- (GPs) can be highly sensitive but less specific for the diag- tices in the east of England. nosis of melanoma [4]; this results in a relatively high pro- portion of excision biopsies [5] and secondary health care To facilitate the learning of the assessment of MoleMate™ referrals [6] of benign pigmented skin lesions (PSLs). scans by primary health care providers, a computer pro- gram, the MoleMate™ training program, was developed by To improve the accuracy of melanoma diagnosis by GPs, the manufacturer, Astron Clinica™, and researchers from a variety of diagnostic algorithms and instruments have Cambridge University. The self-administered program been developed. The most widely-published, evaluated takes approximately 90 minutes to complete and trains and revised algorithms are the 'ABCD' [7] and 'Seven users to identify the typical SIAscopic™ features of pig- Point' [8] checklists, each of which has a significant sensi- mented skin lesions including seborrhoeic keratoses, hae- tivity-specificity trade-off [9,10]. The most developed mangiomas, melanocytic naevi and melanomas. diagnostic instruments utilize dermoscopy, multispectral imaging, confocal laser microscopy, ultrasonography, In 2007, researchers from the University of Cambridge, optical coherence tomography, or magnetic resonance UK, tested the MoleMate™ training program on 18 GPs imaging [11]. Short training courses in dermoscopy, the [19]; the aim of this study was to test a similar group of cheapest and most-evaluated method, have been shown Australian GPs and compare the results. to increase the sensitivity of GPs for the diagnosis of melanoma without increasing their specificity [12,13]. A Methods 2002 systematic review of dermoscopy concluded that MoleMate images "...dermoscopy improves the diagnostic accuracy for The computer program produces a colour dermatoscopic image and seven standard MoleMate™ images, or 'Views', melanoma in comparison with inspection by the unaided eye, but only for experienced examiners" [14]. Clearly, to to assess each lesion (see Figure 1 for examples of 'Views'). reduce the number (and cost) of biopsies and referrals of benign moles, GPs require more training and better tools MoleMate training program to improve the specificity of their diagnosis of melanoma. The computer-based training program consists of four, self-administered sections: The MoleMate™ system incorporates a hand-held scanner that utilizes spectrophotometric intracutaneous analysis 1. Demonstration of the typical MoleMate™ features of 13 (SIAscopy™) to produce images of the light-absorbing moles; chromophores haemoglobin, melanin and collagen in the epidermis and papillary dermis. Certain features of these 2. Pre-test of 30 MoleMate™ scans; images are combined with a customized diagnostic algo- rithm to predict the 'suspiciousness', or 'potential malig- 3. Tailored feedback of each pre-test answer for each scan nancy' of scanned lesions, indicating the need for biopsy (see Figure 2 for a feedback example); or referral. Using an algorithm derived from patients referred to a hospital skin cancer clinic, SIAscopy™ has 4. Post-test of 30 MoleMate™ scans. Page 2 of 5 (page number not for citation purposes) Asia Pacific Family Medicine 2009, 8:3 http://www.apfmj.com/content/8/1/3 Analysis Data were analysed using SPSS 15.0; pre- and post-test scores were compared using the Wilcoxon Signed-Rank Test for paired data and the Mann-Whitney U Test (using the exact two-tailed probability test) for unpaired data; p values less than 0.05 were regarded as statistically signifi- cant. Results The personal data of the Australian and English GPs and GP registrars are summarized in Table 1. Effectiveness of the MoleMate training program Accuracy The median pre- and post-test scores for the 30 Australian GPs were 79.5% (inter-quartile range (IQR 73.8% – 85.0%) and 86.5% (IQR 81.0% – 90.0%): median Overview of MoleMate™ tra Figure 1 ining program showing 'Views' Overview of MoleMate™ training program showing improvement 5.5% (IQR 1.0%–11.3%, p < 0.001). 'Views'. The median pre- and post-test scores for the 18 English GPs were 74.5% (IQR 70.8% – 79.0%) and 86.5% (IQR The program calculates a total score from the percentage 82.5% – 89.0%): median improvement 9.5% (IQR 6.5%– of correct answers and the time it takes for each lesion to 14.0%, p < 0.001). be assessed. The pre- and post-test scores for each MoleMate™ scan fea- Workshops ture are shown in Figure 3. The Australian GPs signifi- In Cambridge, 18 GPs were recruited by flyer and email to cantly improved their scores for all the features except for attend one of two evening workshops in Cambridge dur- the 'melanin brain' feature, while the English GPs signifi- ing March and April 2007. In Perth, 31 GPs were recruited cantly improved their scores for all the features except for by mail and email to attend an evening workshop in the 'melanin brain' and 'dermal melanin' features. March 2008. After a 10-minute demonstration of the MoleMate™ system, the GPs were given 90 minutes, The Australian GPs had higher pre-test scores than the including a refreshment break, to complete the training English GPs (p = 0.045) but, except for a lower score for program. One GP was unable to complete the program the 'dermal melanin' feature by the English GPs (p = due to a computer malfunction. 0.02), the post-test scores were not significantly different. There were no significant differences between the total pre- or post-test scores of the 8 English GPs and 10 English GP registrars, but the registrars had significantly lower scores for the 'dermal melanin' feature on the pre-test (p = 0.036) and for the 'melanin brain' feature on the post-test (p = 0.016). There were no significant differences in pre- or post-test scores between Australian GPs who routinely used der- moscopy and those who didn't and between English GPs with post-graduate dermatology training and those with- out. Speed The median average times taken by the Australian and English GPs to assess each lesion decreased from 43 to 35 seconds (p < 0.001) and from 47 to 36 seconds (p < F Figure 2 eedback section of MoleMate™ training program Feedback section of MoleMate™ training program. 0.001), respectively. Page 3 of 5 (page number not for citation purposes) Asia Pacific Family Medicine 2009, 8:3 http://www.apfmj.com/content/8/1/3 Table 1: Summary of the personal data for GPs Perth Cambridge GPs GPs GP registrars Average age (range) in years 51 (28–75) 48 (34–60) 31 (26–40) Females 13 (43%) 4 (50%) 7 (70%) Males 17 (57%) 4 (50%) 3 (30%) Average years of general practice (range) 19 (2–45) 17 (9–25) 0.75 (0.5–1.0) Routine use of dermoscopy 12 (40%) n/a n/a Dermatology training n/a 5 (63%) 1 (10%) n/a Not assessed. There were no significant differences in the pre- or post- that the pre- and post-test skin lesions were different for test times between the 30 Australian and 18 English GPs both groups of GPs, and that the English GPs and GP reg- or between the 8 English GPs and 10 English GP registrars. istrars had similar post-test scores, the results suggest that the MoleMate™ training program is effective, (i.e. it improves the ability of individual GPs to assess SIAscopy™ Discussion The most remarkable finding of this study was the similar- features), and it is reliable (i.e. it is effective for different ity of the post-test scores of the Australian and English groups of GPs). GPs; although English GPs scored significantly lower on the pre-test than the Australian GPs, their median post- Presumably, the Australian GPs scored higher than the test score was identical, with only one feature (dermal English GPs on the pre-test because they had more general melanin) having a significantly lower score. Considering practice experience and more experience diagnosing PSLs. Pre-test vs Figure 3 Post-test scores by MoleMate™ feature: Perth vs Cambridge GPs Pre-test vs Post-test scores by MoleMate™ feature: Perth vs Cambridge GPs. Page 4 of 5 (page number not for citation purposes) Asia Pacific Family Medicine 2009, 8:3 http://www.apfmj.com/content/8/1/3 Although 40% of the Australian GPs routinely used der- and helped draft the manuscript. TW performed the statis- moscopy – some SIAscopy™ features are similar to those tical analysis and drafted the manuscript. All authors read seen with dermoscopy – there were no significant differ- and approved the final manuscript. ences in pre- or post-test scores between those who did and those who did not use dermoscopy. Similarly, there References 1. AIHW (Australian Institute of Health and Welfare) & AACR (Austral- were no significant differences in pre- or post-test scores asian Association of Cancer Registries) 2007: Cancer in Australia: between the 33% of English GPs with postgraduate der- an overview, 2006. In Cancer series no. 37. Cat. no. CAN 32 Can- matology training and those without. This suggests that berra: AIHW. 2. Australian Institute of Health and Welfare: Cancer incidence data SIAscopy™ features are relatively easy to learn without pre- cubes: [http://www.aihw.gov.au/cancer/data/datacubes/index.cfm]. vious dermatology experience. accessed 4 April 2008. 3. National Health and Medical Research Council: Clinical practice guidelines: the management of cutaneous melanoma. Can- Neither group improved their scores for the 'melanin berra: Australian Cancer Network; 1999. brain' feature, which, except for the uniqueness of the 4. Burton RC, Howe C, Adamson L, Reid AL, Hersey P, Watson A, Watt G, Relic J, Holt D, Thursfield V, Clarke P, Armstrong BK: Gen- image, is hard to explain; this feature is important for eral practitioner screening for melanoma: sensitivity, specif- identifying seborrhoeic keratoses, benign lesions that are icity and effect of training. J Med Screen 1998, 5:156-61. frequently referred to specialists. 5. English DR, Del Mar C, Burton RC: Factors influencing the number needed to excise: excision rates of pigmented lesions by general practitioners. Med J Aust 2004, 180:16-19. GPs consistently scored greater than 90 percent for only 6. Morrison A, O'Loughlin SS, Powell FC: Suspected skin malig- nancy: a comparison of family practitioners and dermatolo- one feature: dermal melanin. Further research is required gists in 493 patients. Int J Dermatol 2001, 40:104-7. to determine the amount of training GPs require to 7. Friedman RJ, Rigel DS, Kopf AW: Early detection of malignant achieve the accuracy of a MoleMate™ expert. melanoma: the role of physician examination and self-exam- ination of the skin. CA Cancer J Clin 1985, 35:130-51. 8. MacKie R: Clinical recognition of early invasive malignant There are some significant limitations to this study: the melanoma – looking for changes in size, shape, and colour is samples of GPs were small and not random, the English successful. Br Med J 1990, 301:1005-06. 9. Whited JD, Grichnik CM: Does this patient have a mole or GPs were less experienced, and diagnostic accuracy was melanoma? JAMA 1998, 279:696-701. not evaluated. However, the training program was 10. Liu W, Hill D, Gibbs AF, Tempany M, Howe C, Borland R, Morand M, Kelly JW: What features do patients notice that help to distin- designed as an introduction to the use of the MoleMate™ guish between benign pigmented lesions and melanomas?: system in clinical practice and should not be considered a the ABCD(E) rules versus the seven-point checklist. stand-alone intervention. The training program and Mole- Melanoma Res 2005, 15:549-54. 11. Marghoob AA, Swindle LD, Moricz CZ, Sanchez N, Slue S, Halpern A, Mate™ system are currently being evaluated in an RCT in Kopf A: Instruments and new technologies for the in vivo general practices in Cambridge, U.K. diagnosis of melanoma. J Am Acad Dermatol 2003, 49:777-97. 12. Westerhoff K, McCarthy WH, Menzies SW: Increase in the sensi- tivity for melanoma diagnosis by primary care physicians Although the results of the SIAscopy™ feature testing can- using skin surface microscopy. Br J Dermatol 2000, 143:1016-20. not be extrapolated to the clinical domain, the results of 13. Argenziano G, Puig S, Zalaudek I, Sera F, Corona R, Alsina M, Barbato , Cristina Carrera F, Ferrara G, Guilabert A, Massi D, Moreno- the speed tests indicates that interpreting MoleMate™ Romero J, Muñoz-Santos C, Petrillo G, Segura S, Soyer HP, Zanchini scans would be relatively quick in clinical practice. R, Malvehy : Dermoscopy improves accuracy of primary care physicians to triage lesions suggestive of skin cancer. J Clin Oncol 2006, 24:1877-82. Conclusion 14. Kittler H, Pehamberger H, Wolff K, Binder M: Diagnostic accuracy Most of the SIAscopy™ features can be learnt to a reasona- of dermoscopy. Lancet Oncol 2002, 3:159-65. 15. Moncrieff M, Cotton S, Claridge E, Hall P: Spectrophotometric ble degree of accuracy with this brief computer training intracutaneous analysis: a new technique for imaging pig- program. Although the Australian GPs scored higher in mented skin lesions. Br J Dermatol 2002, 146:448-57. the pre-test, both groups had similar levels of accuracy 16. Binder M, Puespoeck-Schwarz M, Steiner A, Kittler H, Muellner M, Wolff K, Pehamberger H: Epiluminescence microscopy of small and speed in interpreting the SIAscopy™ features after pigmented lesions: short-tem formal training improves the completing the program. Scores were not affected by pre- diagnostic performance of dermatologists. J Am Acad Dermatol vious dermoscopy experience or dermatology training, 1997, 36:197-202. 17. Hunter J: Triaging suspicious pigmented skin lesions in pri- indicating that the MoleMate™ system is relatively easy to mary care using the SIAscope. In MD Thesis University of Cam- learn without previous dermatology experience. bridge; 2007. 18. Chen S, Bravata D, Weil E, Olkin I: A comparison of dermatolo- gists' and primary car physicians' accuracy in diagnosing Competing interests melanoma: a systematic review. Arch Dermatol 2001, TW and the workshops were funded by Astron Clinica™. 137:1627-34. 19. Wood A, Morris H, Emery J, Hall P, Cotton S, Prevost AT, Walter FM: Evaluation of the MoleMate™ training programme for Authors' contributions assessment of suspicious pigmented lesions in primary care. Inform Prim Care 2008, 16:41-50. JE, TW and SK conducted and analysed the Perth work- shop. FW, PH, AW and HM conducted and analysed the Cambridge workshops. JE and FW conceived the study Page 5 of 5 (page number not for citation purposes) http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Asia Pacific Family Medicine Springer Journals

Learning a novel technique to identify possible melanomas: are Australian general practitioners better than their U.K. colleagues?

Learning a novel technique to identify possible melanomas: are Australian general practitioners better than their U.K. colleagues?

Background: Spectrophotometric intracutaneous analysis (SIAscopy™) is a multispectral imaging technique that is used to identify 'suspicious' (i.e. potentially malignant) pigmented skin lesions for further investigation. The MoleMate™ system is a hand-held scanner that captures SIAscopy™ images that are then classified by the clinician using a computerized diagnostic algorithm designed for the primary health care setting. The objectives of this study were to test the effectiveness of a computer program designed to train health care workers to identify the diagnostic features of SIAscopy™ images and compare the results of a group of Australian and a group of English general practitioners (GPs). Methods: Thirty GPs recruited from the Perth (Western Australia) metropolitan area completed the training program at a workshop held in March 2008. The accuracy and speed of their pre- and post-test scores were then compared with those of a group of 18 GPs (including 10 GP registrars) who completed a similar program at two workshops held in Cambridge (U.K.) in March and April, Results: The median test score of the Australian GPs improved from 79.5% to 86.5% (median increase 5.5%; p < 0.001) while the median test score of the English GPs improved from 74.5% to 86.5% (median increase 9.5%; p < 0.001). The Australian GPs had significantly higher pre-test scores but there were no significant differences in post-test scores between the Australian and English GPs or between the GPs and GP registrars. There was no significant difference in scores between GPs with previous dermoscopy experience or dermatology training. Conclusion: Most of the SIAscopy™ features can be learnt to a reasonable degree of accuracy with this brief computer training program. Although the Australian GPs scored higher in the pre- test, both groups had similar levels of accuracy and speed in interpreting the SIAscopy™ features after completing the program. Scores were not affected by previous dermoscopy experience or dermatology training, which suggests that the MoleMate™ system is relatively easy to learn. Page 1 of 5 (page number not for citation purposes) Asia Pacific Family Medicine 2009, 8:3 http://www.apfmj.com/content/8/1/3 been shown to have a sensitivity of 82.7% (95% confi- Background In Australia, skin cancer is the most common cancer, with dence interval [CI] 70.3% – 90.6%) and specificity of melanoma being the fourth most common registrable 80.1% (95% CI 75.1% – 84.2%) for the diagnosis of cancer after prostate, colorectal, and breast cancer [1]. In melanoma [15]. Receiver-operator characteristic analysis 2003, there were 9,524 new cases of melanoma – a 14% showed that the SIAscopy™ experts achieved a diagnostic increase in incidence since 1993 – and 1,146 deaths (764 accuracy similar to that of 11 dermatologists with 9 hours males and 382 females) [1]. The risk of developing of dermoscopy training [16]. The MoleMate™ system, melanoma before the age of 75 is 1 in 24 for males and 1 which uses a diagnostic algorithm derived from patients in 34 for females [1]; melanoma is the most common can- attending primary health care clinics, has been shown to cer in the 20 to 39 year old age group [2]. have a sensitivity of 100% (95% CI 44% – 100%) and spe- cificity of 78% (95% CI 75% – 82%) for the diagnosis of Because the prognosis for melanoma is very good when melanoma [17]. For comparison, a 2001 systematic lesions are excised 'early' (97.9% 10-year survival ≤ 0.75 review of studies of unaided clinical diagnostic accuracy mm Breslow thickness) and poor when they are not (40% for melanoma found that biopsy or referral sensitivity and 10-year survival > 4 mm Breslow thickness), the National specificity were 82–100% and 70–89% for dermatologists Health and Medical Research Council has emphasized the and 70–88% and 70–87% for Primary Care Physicians importance of the early diagnosis of melanoma [3]. When (GPs) [18]. The MoleMate™ system is currently undergo- compared with dermatologists, General Practitioners ing a randomised controlled trial (RCT) in general prac- (GPs) can be highly sensitive but less specific for the diag- tices in the east of England. nosis of melanoma [4]; this results in a relatively high pro- portion of excision biopsies [5] and secondary health care To facilitate the learning of the assessment of MoleMate™ referrals [6] of benign pigmented skin lesions (PSLs). scans by primary health care providers, a computer pro- gram, the MoleMate™ training program, was developed by To improve the accuracy of melanoma diagnosis by GPs, the manufacturer, Astron Clinica™, and researchers from a variety of diagnostic algorithms and instruments have Cambridge University. The self-administered program been developed. The most widely-published, evaluated takes approximately 90 minutes to complete and trains and revised algorithms are the 'ABCD' [7] and 'Seven users to identify the typical SIAscopic™ features of pig- Point' [8] checklists, each of which has a significant sensi- mented skin lesions including seborrhoeic keratoses, hae- tivity-specificity trade-off [9,10]. The most developed mangiomas, melanocytic naevi and melanomas. diagnostic instruments utilize dermoscopy, multispectral imaging, confocal laser microscopy, ultrasonography, In 2007, researchers from the University of Cambridge, optical coherence tomography, or magnetic resonance UK, tested the MoleMate™ training program on 18 GPs imaging [11]. Short training courses in dermoscopy, the [19]; the aim of this study was to test a similar group of cheapest and most-evaluated method, have been shown Australian GPs and compare the results. to increase the sensitivity of GPs for the diagnosis of melanoma without increasing their specificity [12,13]. A Methods 2002 systematic review of dermoscopy concluded that MoleMate images "...dermoscopy improves the diagnostic accuracy for The computer program produces a colour dermatoscopic image and seven standard MoleMate™ images, or 'Views', melanoma in comparison with inspection by the unaided eye, but only for experienced examiners" [14]. Clearly, to to assess each lesion (see Figure 1 for examples of 'Views'). reduce the number (and cost) of biopsies and referrals of benign moles, GPs require more training and better tools MoleMate training program to improve the specificity of their diagnosis of melanoma. The computer-based training program consists of four, self-administered sections: The MoleMate™ system incorporates a hand-held scanner that utilizes spectrophotometric intracutaneous analysis 1. Demonstration of the typical MoleMate™ features of 13 (SIAscopy™) to produce images of the light-absorbing moles; chromophores haemoglobin, melanin and collagen in the epidermis and papillary dermis. Certain features of these 2. Pre-test of 30 MoleMate™ scans; images are combined with a customized diagnostic algo- rithm to predict the 'suspiciousness', or 'potential malig- 3. Tailored feedback of each pre-test answer for each scan nancy' of scanned lesions, indicating the need for biopsy (see Figure 2 for a feedback example); or referral. Using an algorithm derived from patients referred to a hospital skin cancer clinic, SIAscopy™ has 4. Post-test of 30 MoleMate™ scans. Page 2 of 5 (page number not for citation purposes) Asia Pacific Family Medicine 2009, 8:3 http://www.apfmj.com/content/8/1/3 Analysis Data were analysed using SPSS 15.0; pre- and post-test scores were compared using the Wilcoxon Signed-Rank Test for paired data and the Mann-Whitney U Test (using the exact two-tailed probability test) for unpaired data; p values less than 0.05 were regarded as statistically signifi- cant. Results The personal data of the Australian and English GPs and GP registrars are summarized in Table 1. Effectiveness of the MoleMate training program Accuracy The median pre- and post-test scores for the 30 Australian GPs were 79.5% (inter-quartile range (IQR 73.8% – 85.0%) and 86.5% (IQR 81.0% – 90.0%): median Overview of MoleMate™ tra Figure 1 ining program showing 'Views' Overview of MoleMate™ training program showing improvement 5.5% (IQR 1.0%–11.3%, p < 0.001). 'Views'. The median pre- and post-test scores for the 18 English GPs were 74.5% (IQR 70.8% – 79.0%) and 86.5% (IQR The program calculates a total score from the percentage 82.5% – 89.0%): median improvement 9.5% (IQR 6.5%– of correct answers and the time it takes for each lesion to 14.0%, p < 0.001). be assessed. The pre- and post-test scores for each MoleMate™ scan fea- Workshops ture are shown in Figure 3. The Australian GPs signifi- In Cambridge, 18 GPs were recruited by flyer and email to cantly improved their scores for all the features except for attend one of two evening workshops in Cambridge dur- the 'melanin brain' feature, while the English GPs signifi- ing March and April 2007. In Perth, 31 GPs were recruited cantly improved their scores for all the features except for by mail and email to attend an evening workshop in the 'melanin brain' and 'dermal melanin' features. March 2008. After a 10-minute demonstration of the MoleMate™ system, the GPs were given 90 minutes, The Australian GPs had higher pre-test scores than the including a refreshment break, to complete the training English GPs (p = 0.045) but, except for a lower score for program. One GP was unable to complete the program the 'dermal melanin' feature by the English GPs (p = due to a computer malfunction. 0.02), the post-test scores were not significantly different. There were no significant differences between the total pre- or post-test scores of the 8 English GPs and 10 English GP registrars, but the registrars had significantly lower scores for the 'dermal melanin' feature on the pre-test (p = 0.036) and for the 'melanin brain' feature on the post-test (p = 0.016). There were no significant differences in pre- or post-test scores between Australian GPs who routinely used der- moscopy and those who didn't and between English GPs with post-graduate dermatology training and those with- out. Speed The median average times taken by the Australian and English GPs to assess each lesion decreased from 43 to 35 seconds (p < 0.001) and from 47 to 36 seconds (p < F Figure 2 eedback section of MoleMate™ training program Feedback section of MoleMate™ training program. 0.001), respectively. Page 3 of 5 (page number not for citation purposes) Asia Pacific Family Medicine 2009, 8:3 http://www.apfmj.com/content/8/1/3 Table 1: Summary of the personal data for GPs Perth Cambridge GPs GPs GP registrars Average age (range) in years 51 (28–75) 48 (34–60) 31 (26–40) Females 13 (43%) 4 (50%) 7 (70%) Males 17 (57%) 4 (50%) 3 (30%) Average years of general practice (range) 19 (2–45) 17 (9–25) 0.75 (0.5–1.0) Routine use of dermoscopy 12 (40%) n/a n/a Dermatology training n/a 5 (63%) 1 (10%) n/a Not assessed. There were no significant differences in the pre- or post- that the pre- and post-test skin lesions were different for test times between the 30 Australian and 18 English GPs both groups of GPs, and that the English GPs and GP reg- or between the 8 English GPs and 10 English GP registrars. istrars had similar post-test scores, the results suggest that the MoleMate™ training program is effective, (i.e. it improves the ability of individual GPs to assess SIAscopy™ Discussion The most remarkable finding of this study was the similar- features), and it is reliable (i.e. it is effective for different ity of the post-test scores of the Australian and English groups of GPs). GPs; although English GPs scored significantly lower on the pre-test than the Australian GPs, their median post- Presumably, the Australian GPs scored higher than the test score was identical, with only one feature (dermal English GPs on the pre-test because they had more general melanin) having a significantly lower score. Considering practice experience and more experience diagnosing PSLs. Pre-test vs Figure 3 Post-test scores by MoleMate™ feature: Perth vs Cambridge GPs Pre-test vs Post-test scores by MoleMate™ feature: Perth vs Cambridge GPs. Page 4 of 5 (page number not for citation purposes) Asia Pacific Family Medicine 2009, 8:3 http://www.apfmj.com/content/8/1/3 Although 40% of the Australian GPs routinely used der- and helped draft the manuscript. TW performed the statis- moscopy – some SIAscopy™ features are similar to those tical analysis and drafted the manuscript. All authors read seen with dermoscopy – there were no significant differ- and approved the final manuscript. ences in pre- or post-test scores between those who did and those who did not use dermoscopy. Similarly, there References 1. AIHW (Australian Institute of Health and Welfare) & AACR (Austral- were no significant differences in pre- or post-test scores asian Association of Cancer Registries) 2007: Cancer in Australia: between the 33% of English GPs with postgraduate der- an overview, 2006. In Cancer series no. 37. Cat. no. CAN 32 Can- matology training and those without. This suggests that berra: AIHW. 2. Australian Institute of Health and Welfare: Cancer incidence data SIAscopy™ features are relatively easy to learn without pre- cubes: [http://www.aihw.gov.au/cancer/data/datacubes/index.cfm]. vious dermatology experience. accessed 4 April 2008. 3. National Health and Medical Research Council: Clinical practice guidelines: the management of cutaneous melanoma. Can- Neither group improved their scores for the 'melanin berra: Australian Cancer Network; 1999. brain' feature, which, except for the uniqueness of the 4. Burton RC, Howe C, Adamson L, Reid AL, Hersey P, Watson A, Watt G, Relic J, Holt D, Thursfield V, Clarke P, Armstrong BK: Gen- image, is hard to explain; this feature is important for eral practitioner screening for melanoma: sensitivity, specif- identifying seborrhoeic keratoses, benign lesions that are icity and effect of training. J Med Screen 1998, 5:156-61. frequently referred to specialists. 5. English DR, Del Mar C, Burton RC: Factors influencing the number needed to excise: excision rates of pigmented lesions by general practitioners. Med J Aust 2004, 180:16-19. GPs consistently scored greater than 90 percent for only 6. Morrison A, O'Loughlin SS, Powell FC: Suspected skin malig- nancy: a comparison of family practitioners and dermatolo- one feature: dermal melanin. Further research is required gists in 493 patients. Int J Dermatol 2001, 40:104-7. to determine the amount of training GPs require to 7. Friedman RJ, Rigel DS, Kopf AW: Early detection of malignant achieve the accuracy of a MoleMate™ expert. melanoma: the role of physician examination and self-exam- ination of the skin. CA Cancer J Clin 1985, 35:130-51. 8. MacKie R: Clinical recognition of early invasive malignant There are some significant limitations to this study: the melanoma – looking for changes in size, shape, and colour is samples of GPs were small and not random, the English successful. Br Med J 1990, 301:1005-06. 9. Whited JD, Grichnik CM: Does this patient have a mole or GPs were less experienced, and diagnostic accuracy was melanoma? JAMA 1998, 279:696-701. not evaluated. However, the training program was 10. Liu W, Hill D, Gibbs AF, Tempany M, Howe C, Borland R, Morand M, Kelly JW: What features do patients notice that help to distin- designed as an introduction to the use of the MoleMate™ guish between benign pigmented lesions and melanomas?: system in clinical practice and should not be considered a the ABCD(E) rules versus the seven-point checklist. stand-alone intervention. The training program and Mole- Melanoma Res 2005, 15:549-54. 11. Marghoob AA, Swindle LD, Moricz CZ, Sanchez N, Slue S, Halpern A, Mate™ system are currently being evaluated in an RCT in Kopf A: Instruments and new technologies for the in vivo general practices in Cambridge, U.K. diagnosis of melanoma. J Am Acad Dermatol 2003, 49:777-97. 12. Westerhoff K, McCarthy WH, Menzies SW: Increase in the sensi- tivity for melanoma diagnosis by primary care physicians Although the results of the SIAscopy™ feature testing can- using skin surface microscopy. Br J Dermatol 2000, 143:1016-20. not be extrapolated to the clinical domain, the results of 13. Argenziano G, Puig S, Zalaudek I, Sera F, Corona R, Alsina M, Barbato , Cristina Carrera F, Ferrara G, Guilabert A, Massi D, Moreno- the speed tests indicates that interpreting MoleMate™ Romero J, Muñoz-Santos C, Petrillo G, Segura S, Soyer HP, Zanchini scans would be relatively quick in clinical practice. R, Malvehy : Dermoscopy improves accuracy of primary care physicians to triage lesions suggestive of skin cancer. J Clin Oncol 2006, 24:1877-82. Conclusion 14. Kittler H, Pehamberger H, Wolff K, Binder M: Diagnostic accuracy Most of the SIAscopy™ features can be learnt to a reasona- of dermoscopy. Lancet Oncol 2002, 3:159-65. 15. Moncrieff M, Cotton S, Claridge E, Hall P: Spectrophotometric ble degree of accuracy with this brief computer training intracutaneous analysis: a new technique for imaging pig- program. Although the Australian GPs scored higher in mented skin lesions. Br J Dermatol 2002, 146:448-57. the pre-test, both groups had similar levels of accuracy 16. Binder M, Puespoeck-Schwarz M, Steiner A, Kittler H, Muellner M, Wolff K, Pehamberger H: Epiluminescence microscopy of small and speed in interpreting the SIAscopy™ features after pigmented lesions: short-tem formal training improves the completing the program. Scores were not affected by pre- diagnostic performance of dermatologists. J Am Acad Dermatol vious dermoscopy experience or dermatology training, 1997, 36:197-202. 17. Hunter J: Triaging suspicious pigmented skin lesions in pri- indicating that the MoleMate™ system is relatively easy to mary care using the SIAscope. In MD Thesis University of Cam- learn without previous dermatology experience. bridge; 2007. 18. Chen S, Bravata D, Weil E, Olkin I: A comparison of dermatolo- gists' and primary car physicians' accuracy in diagnosing Competing interests melanoma: a systematic review. Arch Dermatol 2001, TW and the workshops were funded by Astron Clinica™. 137:1627-34. 19. Wood A, Morris H, Emery J, Hall P, Cotton S, Prevost AT, Walter FM: Evaluation of the MoleMate™ training programme for Authors' contributions assessment of suspicious pigmented lesions in primary care. Inform Prim Care 2008, 16:41-50. JE, TW and SK conducted and analysed the Perth work- shop. FW, PH, AW and HM conducted and analysed the Cambridge workshops. JE and FW conceived the study Page 5 of 5 (page number not for citation purposes)
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Springer Journals
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Copyright © 2009 by Watson et al; licensee BioMed Central Ltd.
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Medicine & Public Health; General Practice / Family Medicine; Primary Care Medicine
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1447-056X
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19402916
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Abstract

Background: Spectrophotometric intracutaneous analysis (SIAscopy™) is a multispectral imaging technique that is used to identify 'suspicious' (i.e. potentially malignant) pigmented skin lesions for further investigation. The MoleMate™ system is a hand-held scanner that captures SIAscopy™ images that are then classified by the clinician using a computerized diagnostic algorithm designed for the primary health care setting. The objectives of this study were to test the effectiveness of a computer program designed to train health care workers to identify the diagnostic features of SIAscopy™ images and compare the results of a group of Australian and a group of English general practitioners (GPs). Methods: Thirty GPs recruited from the Perth (Western Australia) metropolitan area completed the training program at a workshop held in March 2008. The accuracy and speed of their pre- and post-test scores were then compared with those of a group of 18 GPs (including 10 GP registrars) who completed a similar program at two workshops held in Cambridge (U.K.) in March and April, Results: The median test score of the Australian GPs improved from 79.5% to 86.5% (median increase 5.5%; p < 0.001) while the median test score of the English GPs improved from 74.5% to 86.5% (median increase 9.5%; p < 0.001). The Australian GPs had significantly higher pre-test scores but there were no significant differences in post-test scores between the Australian and English GPs or between the GPs and GP registrars. There was no significant difference in scores between GPs with previous dermoscopy experience or dermatology training. Conclusion: Most of the SIAscopy™ features can be learnt to a reasonable degree of accuracy with this brief computer training program. Although the Australian GPs scored higher in the pre- test, both groups had similar levels of accuracy and speed in interpreting the SIAscopy™ features after completing the program. Scores were not affected by previous dermoscopy experience or dermatology training, which suggests that the MoleMate™ system is relatively easy to learn. Page 1 of 5 (page number not for citation purposes) Asia Pacific Family Medicine 2009, 8:3 http://www.apfmj.com/content/8/1/3 been shown to have a sensitivity of 82.7% (95% confi- Background In Australia, skin cancer is the most common cancer, with dence interval [CI] 70.3% – 90.6%) and specificity of melanoma being the fourth most common registrable 80.1% (95% CI 75.1% – 84.2%) for the diagnosis of cancer after prostate, colorectal, and breast cancer [1]. In melanoma [15]. Receiver-operator characteristic analysis 2003, there were 9,524 new cases of melanoma – a 14% showed that the SIAscopy™ experts achieved a diagnostic increase in incidence since 1993 – and 1,146 deaths (764 accuracy similar to that of 11 dermatologists with 9 hours males and 382 females) [1]. The risk of developing of dermoscopy training [16]. The MoleMate™ system, melanoma before the age of 75 is 1 in 24 for males and 1 which uses a diagnostic algorithm derived from patients in 34 for females [1]; melanoma is the most common can- attending primary health care clinics, has been shown to cer in the 20 to 39 year old age group [2]. have a sensitivity of 100% (95% CI 44% – 100%) and spe- cificity of 78% (95% CI 75% – 82%) for the diagnosis of Because the prognosis for melanoma is very good when melanoma [17]. For comparison, a 2001 systematic lesions are excised 'early' (97.9% 10-year survival ≤ 0.75 review of studies of unaided clinical diagnostic accuracy mm Breslow thickness) and poor when they are not (40% for melanoma found that biopsy or referral sensitivity and 10-year survival > 4 mm Breslow thickness), the National specificity were 82–100% and 70–89% for dermatologists Health and Medical Research Council has emphasized the and 70–88% and 70–87% for Primary Care Physicians importance of the early diagnosis of melanoma [3]. When (GPs) [18]. The MoleMate™ system is currently undergo- compared with dermatologists, General Practitioners ing a randomised controlled trial (RCT) in general prac- (GPs) can be highly sensitive but less specific for the diag- tices in the east of England. nosis of melanoma [4]; this results in a relatively high pro- portion of excision biopsies [5] and secondary health care To facilitate the learning of the assessment of MoleMate™ referrals [6] of benign pigmented skin lesions (PSLs). scans by primary health care providers, a computer pro- gram, the MoleMate™ training program, was developed by To improve the accuracy of melanoma diagnosis by GPs, the manufacturer, Astron Clinica™, and researchers from a variety of diagnostic algorithms and instruments have Cambridge University. The self-administered program been developed. The most widely-published, evaluated takes approximately 90 minutes to complete and trains and revised algorithms are the 'ABCD' [7] and 'Seven users to identify the typical SIAscopic™ features of pig- Point' [8] checklists, each of which has a significant sensi- mented skin lesions including seborrhoeic keratoses, hae- tivity-specificity trade-off [9,10]. The most developed mangiomas, melanocytic naevi and melanomas. diagnostic instruments utilize dermoscopy, multispectral imaging, confocal laser microscopy, ultrasonography, In 2007, researchers from the University of Cambridge, optical coherence tomography, or magnetic resonance UK, tested the MoleMate™ training program on 18 GPs imaging [11]. Short training courses in dermoscopy, the [19]; the aim of this study was to test a similar group of cheapest and most-evaluated method, have been shown Australian GPs and compare the results. to increase the sensitivity of GPs for the diagnosis of melanoma without increasing their specificity [12,13]. A Methods 2002 systematic review of dermoscopy concluded that MoleMate images "...dermoscopy improves the diagnostic accuracy for The computer program produces a colour dermatoscopic image and seven standard MoleMate™ images, or 'Views', melanoma in comparison with inspection by the unaided eye, but only for experienced examiners" [14]. Clearly, to to assess each lesion (see Figure 1 for examples of 'Views'). reduce the number (and cost) of biopsies and referrals of benign moles, GPs require more training and better tools MoleMate training program to improve the specificity of their diagnosis of melanoma. The computer-based training program consists of four, self-administered sections: The MoleMate™ system incorporates a hand-held scanner that utilizes spectrophotometric intracutaneous analysis 1. Demonstration of the typical MoleMate™ features of 13 (SIAscopy™) to produce images of the light-absorbing moles; chromophores haemoglobin, melanin and collagen in the epidermis and papillary dermis. Certain features of these 2. Pre-test of 30 MoleMate™ scans; images are combined with a customized diagnostic algo- rithm to predict the 'suspiciousness', or 'potential malig- 3. Tailored feedback of each pre-test answer for each scan nancy' of scanned lesions, indicating the need for biopsy (see Figure 2 for a feedback example); or referral. Using an algorithm derived from patients referred to a hospital skin cancer clinic, SIAscopy™ has 4. Post-test of 30 MoleMate™ scans. Page 2 of 5 (page number not for citation purposes) Asia Pacific Family Medicine 2009, 8:3 http://www.apfmj.com/content/8/1/3 Analysis Data were analysed using SPSS 15.0; pre- and post-test scores were compared using the Wilcoxon Signed-Rank Test for paired data and the Mann-Whitney U Test (using the exact two-tailed probability test) for unpaired data; p values less than 0.05 were regarded as statistically signifi- cant. Results The personal data of the Australian and English GPs and GP registrars are summarized in Table 1. Effectiveness of the MoleMate training program Accuracy The median pre- and post-test scores for the 30 Australian GPs were 79.5% (inter-quartile range (IQR 73.8% – 85.0%) and 86.5% (IQR 81.0% – 90.0%): median Overview of MoleMate™ tra Figure 1 ining program showing 'Views' Overview of MoleMate™ training program showing improvement 5.5% (IQR 1.0%–11.3%, p < 0.001). 'Views'. The median pre- and post-test scores for the 18 English GPs were 74.5% (IQR 70.8% – 79.0%) and 86.5% (IQR The program calculates a total score from the percentage 82.5% – 89.0%): median improvement 9.5% (IQR 6.5%– of correct answers and the time it takes for each lesion to 14.0%, p < 0.001). be assessed. The pre- and post-test scores for each MoleMate™ scan fea- Workshops ture are shown in Figure 3. The Australian GPs signifi- In Cambridge, 18 GPs were recruited by flyer and email to cantly improved their scores for all the features except for attend one of two evening workshops in Cambridge dur- the 'melanin brain' feature, while the English GPs signifi- ing March and April 2007. In Perth, 31 GPs were recruited cantly improved their scores for all the features except for by mail and email to attend an evening workshop in the 'melanin brain' and 'dermal melanin' features. March 2008. After a 10-minute demonstration of the MoleMate™ system, the GPs were given 90 minutes, The Australian GPs had higher pre-test scores than the including a refreshment break, to complete the training English GPs (p = 0.045) but, except for a lower score for program. One GP was unable to complete the program the 'dermal melanin' feature by the English GPs (p = due to a computer malfunction. 0.02), the post-test scores were not significantly different. There were no significant differences between the total pre- or post-test scores of the 8 English GPs and 10 English GP registrars, but the registrars had significantly lower scores for the 'dermal melanin' feature on the pre-test (p = 0.036) and for the 'melanin brain' feature on the post-test (p = 0.016). There were no significant differences in pre- or post-test scores between Australian GPs who routinely used der- moscopy and those who didn't and between English GPs with post-graduate dermatology training and those with- out. Speed The median average times taken by the Australian and English GPs to assess each lesion decreased from 43 to 35 seconds (p < 0.001) and from 47 to 36 seconds (p < F Figure 2 eedback section of MoleMate™ training program Feedback section of MoleMate™ training program. 0.001), respectively. Page 3 of 5 (page number not for citation purposes) Asia Pacific Family Medicine 2009, 8:3 http://www.apfmj.com/content/8/1/3 Table 1: Summary of the personal data for GPs Perth Cambridge GPs GPs GP registrars Average age (range) in years 51 (28–75) 48 (34–60) 31 (26–40) Females 13 (43%) 4 (50%) 7 (70%) Males 17 (57%) 4 (50%) 3 (30%) Average years of general practice (range) 19 (2–45) 17 (9–25) 0.75 (0.5–1.0) Routine use of dermoscopy 12 (40%) n/a n/a Dermatology training n/a 5 (63%) 1 (10%) n/a Not assessed. There were no significant differences in the pre- or post- that the pre- and post-test skin lesions were different for test times between the 30 Australian and 18 English GPs both groups of GPs, and that the English GPs and GP reg- or between the 8 English GPs and 10 English GP registrars. istrars had similar post-test scores, the results suggest that the MoleMate™ training program is effective, (i.e. it improves the ability of individual GPs to assess SIAscopy™ Discussion The most remarkable finding of this study was the similar- features), and it is reliable (i.e. it is effective for different ity of the post-test scores of the Australian and English groups of GPs). GPs; although English GPs scored significantly lower on the pre-test than the Australian GPs, their median post- Presumably, the Australian GPs scored higher than the test score was identical, with only one feature (dermal English GPs on the pre-test because they had more general melanin) having a significantly lower score. Considering practice experience and more experience diagnosing PSLs. Pre-test vs Figure 3 Post-test scores by MoleMate™ feature: Perth vs Cambridge GPs Pre-test vs Post-test scores by MoleMate™ feature: Perth vs Cambridge GPs. Page 4 of 5 (page number not for citation purposes) Asia Pacific Family Medicine 2009, 8:3 http://www.apfmj.com/content/8/1/3 Although 40% of the Australian GPs routinely used der- and helped draft the manuscript. TW performed the statis- moscopy – some SIAscopy™ features are similar to those tical analysis and drafted the manuscript. All authors read seen with dermoscopy – there were no significant differ- and approved the final manuscript. ences in pre- or post-test scores between those who did and those who did not use dermoscopy. Similarly, there References 1. AIHW (Australian Institute of Health and Welfare) & AACR (Austral- were no significant differences in pre- or post-test scores asian Association of Cancer Registries) 2007: Cancer in Australia: between the 33% of English GPs with postgraduate der- an overview, 2006. In Cancer series no. 37. Cat. no. CAN 32 Can- matology training and those without. This suggests that berra: AIHW. 2. Australian Institute of Health and Welfare: Cancer incidence data SIAscopy™ features are relatively easy to learn without pre- cubes: [http://www.aihw.gov.au/cancer/data/datacubes/index.cfm]. vious dermatology experience. accessed 4 April 2008. 3. National Health and Medical Research Council: Clinical practice guidelines: the management of cutaneous melanoma. Can- Neither group improved their scores for the 'melanin berra: Australian Cancer Network; 1999. brain' feature, which, except for the uniqueness of the 4. Burton RC, Howe C, Adamson L, Reid AL, Hersey P, Watson A, Watt G, Relic J, Holt D, Thursfield V, Clarke P, Armstrong BK: Gen- image, is hard to explain; this feature is important for eral practitioner screening for melanoma: sensitivity, specif- identifying seborrhoeic keratoses, benign lesions that are icity and effect of training. J Med Screen 1998, 5:156-61. frequently referred to specialists. 5. English DR, Del Mar C, Burton RC: Factors influencing the number needed to excise: excision rates of pigmented lesions by general practitioners. Med J Aust 2004, 180:16-19. GPs consistently scored greater than 90 percent for only 6. Morrison A, O'Loughlin SS, Powell FC: Suspected skin malig- nancy: a comparison of family practitioners and dermatolo- one feature: dermal melanin. Further research is required gists in 493 patients. Int J Dermatol 2001, 40:104-7. to determine the amount of training GPs require to 7. Friedman RJ, Rigel DS, Kopf AW: Early detection of malignant achieve the accuracy of a MoleMate™ expert. melanoma: the role of physician examination and self-exam- ination of the skin. CA Cancer J Clin 1985, 35:130-51. 8. MacKie R: Clinical recognition of early invasive malignant There are some significant limitations to this study: the melanoma – looking for changes in size, shape, and colour is samples of GPs were small and not random, the English successful. Br Med J 1990, 301:1005-06. 9. Whited JD, Grichnik CM: Does this patient have a mole or GPs were less experienced, and diagnostic accuracy was melanoma? JAMA 1998, 279:696-701. not evaluated. However, the training program was 10. Liu W, Hill D, Gibbs AF, Tempany M, Howe C, Borland R, Morand M, Kelly JW: What features do patients notice that help to distin- designed as an introduction to the use of the MoleMate™ guish between benign pigmented lesions and melanomas?: system in clinical practice and should not be considered a the ABCD(E) rules versus the seven-point checklist. stand-alone intervention. The training program and Mole- Melanoma Res 2005, 15:549-54. 11. Marghoob AA, Swindle LD, Moricz CZ, Sanchez N, Slue S, Halpern A, Mate™ system are currently being evaluated in an RCT in Kopf A: Instruments and new technologies for the in vivo general practices in Cambridge, U.K. diagnosis of melanoma. J Am Acad Dermatol 2003, 49:777-97. 12. Westerhoff K, McCarthy WH, Menzies SW: Increase in the sensi- tivity for melanoma diagnosis by primary care physicians Although the results of the SIAscopy™ feature testing can- using skin surface microscopy. Br J Dermatol 2000, 143:1016-20. not be extrapolated to the clinical domain, the results of 13. Argenziano G, Puig S, Zalaudek I, Sera F, Corona R, Alsina M, Barbato , Cristina Carrera F, Ferrara G, Guilabert A, Massi D, Moreno- the speed tests indicates that interpreting MoleMate™ Romero J, Muñoz-Santos C, Petrillo G, Segura S, Soyer HP, Zanchini scans would be relatively quick in clinical practice. R, Malvehy : Dermoscopy improves accuracy of primary care physicians to triage lesions suggestive of skin cancer. J Clin Oncol 2006, 24:1877-82. Conclusion 14. Kittler H, Pehamberger H, Wolff K, Binder M: Diagnostic accuracy Most of the SIAscopy™ features can be learnt to a reasona- of dermoscopy. Lancet Oncol 2002, 3:159-65. 15. Moncrieff M, Cotton S, Claridge E, Hall P: Spectrophotometric ble degree of accuracy with this brief computer training intracutaneous analysis: a new technique for imaging pig- program. Although the Australian GPs scored higher in mented skin lesions. Br J Dermatol 2002, 146:448-57. the pre-test, both groups had similar levels of accuracy 16. Binder M, Puespoeck-Schwarz M, Steiner A, Kittler H, Muellner M, Wolff K, Pehamberger H: Epiluminescence microscopy of small and speed in interpreting the SIAscopy™ features after pigmented lesions: short-tem formal training improves the completing the program. Scores were not affected by pre- diagnostic performance of dermatologists. J Am Acad Dermatol vious dermoscopy experience or dermatology training, 1997, 36:197-202. 17. Hunter J: Triaging suspicious pigmented skin lesions in pri- indicating that the MoleMate™ system is relatively easy to mary care using the SIAscope. In MD Thesis University of Cam- learn without previous dermatology experience. bridge; 2007. 18. Chen S, Bravata D, Weil E, Olkin I: A comparison of dermatolo- gists' and primary car physicians' accuracy in diagnosing Competing interests melanoma: a systematic review. Arch Dermatol 2001, TW and the workshops were funded by Astron Clinica™. 137:1627-34. 19. Wood A, Morris H, Emery J, Hall P, Cotton S, Prevost AT, Walter FM: Evaluation of the MoleMate™ training programme for Authors' contributions assessment of suspicious pigmented lesions in primary care. Inform Prim Care 2008, 16:41-50. JE, TW and SK conducted and analysed the Perth work- shop. FW, PH, AW and HM conducted and analysed the Cambridge workshops. JE and FW conceived the study Page 5 of 5 (page number not for citation purposes)

Journal

Asia Pacific Family MedicineSpringer Journals

Published: Apr 30, 2009

References