Online training improves diagnosis of skin cancer in primary care
21 November 2013
Primary care doctors who took an online training course on
diagnosing skin cancer significantly improved their skill to
properly diagnose and manage benign and malignant lesions, according
to a national study from Henry Ford Hospital in Detroit.
The training also resulted in a reduction in unnecessary
referrals to dermatology specialists.
The INFORMED study is believed to be the first of its kind to
track physician practice patterns as an outcome of a skin cancer
detection training course.
There are more new cases of skin cancer in the US than breast,
prostate, lung and colon cancers combined, according to the Skin
Cancer Foundation. Treatment of nonmelanoma skin cancers increased
by nearly 77% between 1992 and 2006. Meanwhile, incidence rates of
melanoma — the most serious form of skin cancer — have been
increasing for at least 30 years. It is estimated that one in 50
Americans will develop melanoma by 2015.
Researchers sought to evaluate whether primary care physicians
(PCP) could diagnose skin cancer if provided targeted, specific
education. PCPs, after all, see more patients than any other
physician group. Fewer than 30% of primary care residents receive
training for performing a skin examination during their medical
The training produced positive results in a number measures:
- scores for diagnosing and managing all skin cancer lesions
- scores for diagnosing benign lesions increased 14%.
- patient referrals for suspicious lesions or new visits to a
dermatology specialist declined as the result of improved
detection by primary care physicians.
- physicians still retained their improved skill level six
“We all know the demands on a physician’s time. But this online
course shows that we can empower primary care physicians to know
when they themselves can take care of some of these patients and
have the confidence in doing so, and not drive up the cost of
utilization with unnecessary referrals to a dermatologist,” says
Melody Eide MD, a Henry Ford dermatologist and the study’s lead
“Improving PCPs skills at diagnosing and managing skin lesions is
an important way to improve patient care because patients frequently
bring skin complaints to their family doctor,” Dr Eide says.
The web-based course covered the three most common skin cancers:
basal cell carcinoma, squamous cell carcinoma and melanoma, and
featured 450 clinical images of lesions.
The participants chose from two web options: traditional textbook
format and case-based format, which took about two to three hours to
complete. The case-based format featured nine case studies with
interactive self-assessment tests and immediate feedback.
Before taking the course in 2011, participants took a pretest of
25 images of skin lesions in which they had to choose a diagnosis
and course of action – reassure or refer. Participants were assessed
a post-test immediately after completing the course, then repeated
six months later.
The findings are published online in the November/December issue
of the Journal of the American Board of Family Medicine at
The course is at: