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皮肤镜检查:皮肤科医生用于黑色素瘤筛查的有用工具:一项全国性调查。

Dermoscopy, a useful tool for general practitioners in melanoma screening: a nationwide survey.

机构信息

Department of General Medicine, Claude Bernard Lyon 1 University, 43 Boulevard 11 Novembre, 1918 BP 761, 69622, Villeurbanne Cedex, France.

Department of Mathematics, Claude Bernard Lyon 1 University, 43 Boulevard 11 Novembre, 1918 BP 761, 69622, Villeurbanne Cedex, France.

出版信息

Br J Dermatol. 2016 Oct;175(4):744-50. doi: 10.1111/bjd.14495. Epub 2016 Jun 30.

Abstract

BACKGROUND

Dermoscopy improves diagnostic accuracy in melanoma, as shown by several meta-analyses. Although it is used by general practitioners (GPs) in Australia, Canada and Italy, no published data on this topic are available in France.

OBJECTIVES

To review the opinions and use of dermoscopy by GPs in France and to understand their practice of skin examination.

METHODS

We designed a descriptive and cross-sectional survey and conducted it between 26 November and 26 December 2014. An anonymous, multiple-choice questionnaire about the demographic characteristics, skin examination modalities and use and training in dermoscopy was sent to 4057 GPs in four large regions of France. Pearson, χ(2) , Student, Welch and Fisher tests were used for cross-tabulation statistical analysis.

RESULTS

Only 8% of respondents had access to a dermoscope; most were male practitioners and aged > 50 years. Dermoscopy increased self-confidence in analysing pigmented lesions (P = 0·004), and dermoscopy users referred fewer patients to dermatologists. The number of biopsies was reduced in the dermoscopy users group (P = 0·004). In total, 425 questionnaires were returned and analysed. Dermoscopy users took more time to evaluate a single pigmented lesion (P = 0·015). Only 16·9% of physicians declared having received some training on dermoscopy, yet this number reached 47% for those owning a dermoscope. Their training was mostly short and recent. Overall 29·2% of the respondents said the main advantage was to reduce the number of referrals to the dermatologists (P = 0·004), while its main disadvantage was the necessity of training (54·6%). Our responders declared they could spend seven working days on a dermoscopy training course.

CONCLUSIONS

Our study demonstrates positive opinions regarding dermoscopy, despite a minority of French GPs using this technique in the areas surveyed. The need for formal training appears to be the main limitation to wider use. Appropriate and specifically designed training programmes should be offered.

摘要

背景

几项荟萃分析表明,皮肤镜检查可提高黑色素瘤的诊断准确性。尽管它在澳大利亚、加拿大和意大利被全科医生(GP)使用,但法国尚未发表有关此主题的任何数据。

目的

回顾法国 GP 对皮肤镜检查的意见和使用情况,并了解他们的皮肤检查实践。

方法

我们设计了一项描述性和横断面调查,并于 2014 年 11 月 26 日至 12 月 26 日进行。向法国四个大区的 4057 名 GP 发送了一份关于人口统计学特征、皮肤检查方式以及皮肤镜检查的使用和培训的匿名、多项选择问卷。使用 Pearson、χ(2)、Student、Welch 和 Fisher 检验进行交叉表统计分析。

结果

只有 8%的受访者可以使用皮肤镜;大多数是男性从业者,年龄 > 50 岁。皮肤镜检查增加了分析色素性病变的自信心(P = 0·004),并且皮肤镜使用者将更少的患者转诊给皮肤科医生。皮肤镜使用者组的活检数量减少(P = 0·004)。共收回并分析了 425 份问卷。皮肤镜使用者评估单个色素性病变所需的时间更长(P = 0·015)。只有 16.9%的医生表示曾接受过皮肤镜检查的培训,但拥有皮肤镜的医生中这一比例达到 47%。他们的培训大多是短期和最近的。总体而言,29.2%的受访者表示,皮肤镜检查的主要优势是减少向皮肤科医生转诊的数量(P = 0·004),而其主要缺点是培训的必要性(54.6%)。我们的受访者表示,他们可以在一个皮肤镜检查培训课程上花费七个工作日。

结论

尽管在调查区域内只有少数法国 GP 使用该技术,但我们的研究表明对皮肤镜检查的意见是积极的。对正规培训的需求似乎是广泛应用的主要限制因素。应提供适当和专门设计的培训计划。

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