De Bedout Valeria, Williams Natalie M, Muñoz Ana M, Londoño Ana M, Munera Manuela, Naranjo Natalí, Rodriguez Lina M, Toro Alejandra M, Miao Feng, Koru-Sengul Tulay, Jaimes Natalia
Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA.
Department of Dermatology, Universidad Pontificia Bolivariana, Medellin, Colombia.
Dermatol Pract Concept. 2021 Jan 29;11(1):e2021145. doi: 10.5826/dpc.1101a145. eCollection 2021 Jan.
The primary objective of this study was to determine the diagnostic accuracy and effect of an educational training on skin cancer course and dermoscopy use among primary care physicians in rural areas of Colombia. The secondary objective was to assess the diagnostic accuracy of skin cancer diagnosis and detection rate after 3 months of the initial training.
Twenty-one primary care physicians from 6 rural areas of Colombia participated in a 2-day skin cancer and dermoscopy training, followed by a day-long hands-on session on dermoscopy at a free skin cancer screening event. Pre- and post-tests were performed using clinical and dermoscopic images to evaluate the user's ability to diagnose and differentiate benign and malignant neoplasms. In addition, participants' levels of confidence were assessed.
After the training, the sensitivity and specificity of characterizing skin lesions as benign or malignant or providing a specific diagnosis (ie, angioma, seborrheic keratosis, basal cell carcinoma, etc.) increased by 23.6% (62.9% to 86.5%; P < 0.0001) and 21% (54.7% to 75.7%; P < 0.0017), respectively. In addition, levels of confidence when diagnosing skin lesions changed from extremely low or low, to high or extremely high by 20.7% (38.3% to 59%) using dermoscopic images (odds ratio (OR) 3.22; 95% confidence interval (CI): 2.67-3.86; P < 0.0001). The secondary objective was not achieved due to loss of follow-up of the majority of participants.
Providers serving populations with limited healthcare access may benefit from education in diagnosing and differentiating skin cancer with the use of dermoscopy, which may ultimately improve patient care and reduce healthcare costs.
本研究的主要目的是确定教育培训对哥伦比亚农村地区初级保健医生皮肤癌病程及皮肤镜使用的诊断准确性和效果。次要目的是评估初始培训3个月后皮肤癌诊断的准确性和检出率。
来自哥伦比亚6个农村地区的21名初级保健医生参加了为期2天的皮肤癌和皮肤镜培训，随后在一次免费皮肤癌筛查活动中参加了为期一天的皮肤镜实践课程。使用临床和皮肤镜图像进行前后测试，以评估使用者诊断和区分良性与恶性肿瘤的能力。此外，还评估了参与者的信心水平。
培训后，将皮肤病变判定为良性或恶性或做出特定诊断（即血管瘤、脂溢性角化病、基底细胞癌等）的敏感性和特异性分别提高了23.6%（从62.9%提高到86.5%；P<0.0001）和21%（从54.7%提高到75.7%；P<0.0017）。此外，使用皮肤镜图像诊断皮肤病变时，信心水平从极低或低变为高或极高的比例为20.7%（从38.3%变为59%）（优势比（OR）3.22；95%置信区间（CI）：2.67 - 3.86；P<0.0001）。由于大多数参与者失访，次要目的未达成。
为医疗服务可及性有限人群提供服务的医疗人员可能会从利用皮肤镜诊断和区分皮肤癌的教育中受益，这最终可能改善患者护理并降低医疗成本。
