A systematic review of research on the use of dermoscopy to triage suspicious skin lesions in primary care settings has concluded that GP dermoscopy can deliver benefits but cautions that minimum training requirements must be determined and implemented.
Researchers led by the University of Cambridge reviewed 23 eligible studies published from 1 January 1990 to 31 December 2017. The studies contained data on 49,769 lesions and 3708 primary care professionals (PCPs), all from high-income countries.
The authors report that there was a paucity of studies set truly in primary care and the outcomes measured were diverse. The heterogeneity made meta-analysis unfeasible and the data were synthesised through narrative review.
The research showed that dermoscopy, with appropriate training, is associated with improved diagnostic accuracy for melanoma and benign lesions, and reduced unnecessary excisions and referrals.
Teledermoscopy-based referral systems improved triage accuracy.
There was insufficient evidence to draw conclusions on cost-effectiveness.
Costs, training and time requirements were identified as important implementation barriers.
In conclusion, the authors said: “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.”
