Training Primary Care Practitioners In Dermoscopy Diagnostic Algorithms Enhances Diagnostic Accuracy and Triage of Suspected Skin Cancer: Scoping Review Evidence

Introduction: In many Western countries, access to a dermatologist can be difficult, while the incidence of skin cancer has risen steadily over the past 50 years. Objective: We reviewed the published literature to determine whether training primary care practitioners (PCPs) in dermoscopy through brief interventions based on diagnostic algorithms could improve patient care by improving their diagnostic accuracy of suspect lesions. Methods: A scoping review of the literature was conducted, focusing on studies published in the period 2003–2023 that assessed the ability of low-experienced PCPs to triage suspicious dermatological lesions using dermoscopic diagnostic algorithms. Regarding outcomes, we focused on quantitative variables relevant to screening practice in general practice, including sensitivity, specificity, referrals to specialists, and unnecessary lesion excisions. Results: Of the 926 studies initially identified, 13 were eventually selected: 10 cross-sectional observational studies and three randomized controlled trials. The studies were carried out in North America (N=6), western Europe (N=4), and Australia (N=3). There was heterogeneity in the training interventions and the criteria used to assess diagnostic accuracy of PCPs after training; however, all studies showed an improvement in this parameter. The preferred algorithms for training PCPs were the 3-point checklist, the 7-point checklist, and the Triage Amalgamated Dermoscopy Algorithm. Conclusion: This review demonstrates the value of training PCPs in dermoscopic diagnostic algorithms through short courses to improve triage of suspicious lesions. However, it is still necessary to define a territorial organization, a precise working framework and limits for PCPs who take on this role.