Evaluating the use of Dermoscopy in the Primary Care Setting in Improving Clinical Outcomes in the Treatment of Melanoma: A Systematic Review
Truitt, Jay Michael
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Melanoma is a significant public health problem and is the most lethal type of skin cancer. Rural and underserved populations have disproportionately worse melanoma-related health outcomes and mortality rates. In these populations, primary care providers are usually the first evaluate, make diagnoses, and initiate referrals/treatments. Dermoscopy, which is a magnification technique using visible light, is increasingly being used in the primary care setting as a tool to improve diagnostic accuracy. Dermoscopy training and the use of teledermoscopy in primary care settings are potential solutions for improving melanoma-related clinical outcomes. The objective of this systematic review was to determine if the use of dermoscopy in a primary care setting can improve clinical outcomes in the treatment of melanoma. This review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines to search for and evaluate relevant studies in four electronic databases (Pubmed, Ovid, CINAHL, and Web of Science) from January 1, 1993 to December 31, 2018. Studies utilizing dermoscopy/teledermoscopy and reporting clinical outcomes associated with melanoma treatment were included. Studies not performed in a primary care/telemedicine setting, and those not concerning melanomas/pigmented skin lesions were excluded. Twenty studies met review criteria, but the heterogeneity of the outcomes measured precluded performance of a meta-analysis, thus data were synthesized in a narrative review. The use of dermoscopy/teledermoscopy in the setting of an adequately trained primary care provider was associated with improved diagnostic accuracy for detecting melanomas, decreased morbidity due to unnecessary removals of benign lesions, and reduced number of dermatology referrals. Cost effectiveness was explored in three of the studies, with two of three finding a significant cost advantage to dermoscopy. Patient acceptability and satisfaction was addressed in one of the studies and was positive. None of the included studies directly addressed the stage of diagnosis, time to diagnosis, or mortality measurements. Thus, widespread implementation of dermoscopy/teledermoscopy in the primary care setting has the potential to improve diagnostic accuracy of suspicious lesions for melanoma and reduce melanoma-related patient morbidity. However, reliable information regarding the amount and type of dermoscopy training needed, the cost effects, patient acceptability/satisfaction and mortality benefits need further exploration.