Dermoscopy of Concerning Pigmented Lesions and Primary Care
Providers’ Referrals at Intervals After Randomized Trial of Mastery
June K. Robinson, MD
, Michael MacLean, MS, PA-C
, Rachel Reavy, PhD
, Rob Turrisi, PhD
Kimberly Mallett, PhD
, and Gary J. Martin, MD
Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA;
Department of Medical Education,
Northwestern University Feinberg School of Medicine, Chicago, IL, USA;
Biobehavioral Health and Prevention Research Center, The Pennsylvania
State University, State College, PA, USA;
Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
J Gen Intern Med 33(6):799–800
© Society of General Internal Medicine 2018
atients visit their primary care provider (PCP) almost
twice yearly and the number of visits increases with
The US Preventive Services Task Force encouraged
screening at-risk patients for melanoma.
We conducted a
randomized trial to assess the efficacy of mastery learning
and found that trained PCPs referred significantly more mel-
anomas and less benign nevi and seborrheic keratoses than
controls in the 3 months after education.
Now, we examine
(a) trained PCPs’ short-term clinical use of dermoscopy and
(b) the electronic medical records (EMRs) of patients of all
PCPs for 6-, 9-, and 12-month referrals. Thus, the effect of
PCP training on patient outcomes, the third phase of transla-
tion science, was assessed.
Short-term Dermoscopy of Patients’ Pigmented
After completing the post-test, a research assistant helped the
44 trained PCPs transmit dermoscopic images of lesions and
their management decisions to the dermatologist (JKR) with a
smartphone equipped with a dermoscope (VEOS DS3
dermoscope, Canfield Scientific, Inc., Fairfield, NJ). Each
PCP selected 12 patients deemed at risk for melanoma due
to a past history of skin cancer (melanoma and/or
nonmelanoma skin cancer), abnormal moles (dysplastic nevi),
multiple blistering sunburns, indoor tanning, or a family his-
tory of melanoma.
The PCP screened areas of the body
exposed during a problem-focused physical examination
(head and neck, arms and hands, and sometimes the chest
and back). Deidentified images were transmitted for 2 weeks
with (1) a designation of benign or clinically concerning and
(2) management recommendations to either reassure the pa-
tient or refer to dermatology. The dermatologist (JKR)
reviewed the images blinded to the identity of the patient,
the PCP, and the PCP’s diagnosis and management plan. After
the dermatologist entered a diagnosis and management plan,
she accessed the PCP’s identity, diagnosis, and management
plan and sent the PCP an email indicating either agreement or
disagreement with the designation and management recom-
mendation. The institutional review board of Northwestern
University approved the study with online consent.
The EMR was reviewed for 6-, 9-, and 12-month referrals. The
6- and 12-month follow-ups were chosen based upon the
course recommendation to follow concerning lesions for
change in 6 and 12 months. Also, the 1-year follow-up
assessed melanomas that may have been missed by the PCPs.
Since the median growth rate for slow-growing melanomas
was 0.12–0.13 mm per month, a 5-mm lesion would increase
by 1.44–1.56 mm in 12 months to 6.44–6.56 mm.
Short-term Dermoscopy of Patient’sLesions
Among the 528 images (one image for each of 12 patients of
44 PCPs), the PCP and dermatologist agreed on 450 (85.23%).
The agreement did not change during the 2 weeks in which
PCPs received comments about their diagnosis and manage-
ment. There were 71 false positives (13.44%), PCP malignant/
dermatologist benign, and 7 false negatives (1.33%), PCP
benign/dermatologist malignant. None of the PCPs purchased
a dermoscope to continue using it.
In our original study, we randomized 89 PCPs; 44 received
mastery training and 45 served as controls. In the year follow-
ing training, these providers served 144,801 patients that are
Published online April 10, 2018