The use of dermatoscopy amongst plastic surgery trainees in the United Kingdom

Dermoscopy Education for Plastic Surgery Residents: How a Brief Theoretical Course and Practical Training Have an Impact

Background

Currently, the evaluation of pigmented skin lesions relies on dermoscopy, which has become the standard of care. As melanoma is one of the principal areas of expertise in plastic surgery, it is essential that diagnostic skills be acquired during the course of specialization. This study aimed to assess the impact and effectiveness of a brief and intensive dermoscopy training program for plastic surgery residents.

Methods

This study was carried out on a group of 41 doctors, who were divided into three categories based on their experience in dermoscopy (none, intermediate, and advanced). A preliminary assessment of each participant's baseline knowledge was conducted by using a 15-query test. Subsequently, the participants attended a 90-minute lecture on diagnostic techniques and the process of differentiating between various skin lesions. To determine the effectiveness of the lecture in improving diagnostic skills, the participants were tested immediately after the lecture and again after a 3-month period.

Results

At the conclusion of the final examination, all three groups achieved an accuracy rate of at least 80% for dermatoscopic diagnosis. However, none of the groups was completely successful. The variations in diagnostic accuracy among the three groups are presented, and P values were calculated for each group.

Conclusion

The short, intensive course of dermoscopy has proven to have a significant positive impact on plastic surgeons in their postdegree training program.

Assessing exposure to dermoscopy in plastic surgery training programs

BACKGROUND

Dermoscopy is a noninvasive tool that improves the diagnostic accuracy of melanoma and other cutaneous malignancies; yet, it is not widely used by plastic surgeons, who commonly manage skin lesions. Thus, the purpose of this study was to explore current practice patterns and knowledge of dermoscopy among plastic surgeons and postgraduate plastic surgery trainees. Additionally, interest to establish a formal dermoscopy curriculum as part of plastic surgery residency training was evaluated.

METHODS

An online electronic questionnaire was developed and distributed through email to practicing plastic surgeons and plastic surgery trainees at two Canadian universities.

RESULTS

Of the 59 potential participants, 27 (46%) responded. While the majority of participants were familiar with dermoscopy (n = 26; 96%), only one respondent reported using dermoscopy in clinical practice. However, all respondents reported exposure to melanoma clinically (n = 26; one participant did not provide a response). A lack of training, along with lack of access to dermatoscopes, were the most frequently cited reasons for not using dermoscopy. Knowledge scores with regard to dermoscopic features were also low; coupled with a noted propensity toward diagnostic or excisional biopsy, whichcould raise the benign to malignant ratio. Overall, 89% (n = 24) of respondents expressed interest in dermoscopy training in plastic surgery postgraduate training.

CONCLUSIONS

Few responding plastic surgeons or plastic surgery residents currently use dermoscopy in training or practice but are interested in formal dermoscopy training in residency.

Diagnostic effectiveness of dermoscopy performed by plastic surgery registrars trained in melanoma diagnosis

BACKGROUND

Dermoscopy improves sensitivity and specificity and helps in the early detection of melanoma and nonmelanoma skin cancers (NMSC). Because of the multidisciplinary approach to melanoma, plastic surgeons may be required to perform dermoscopy evaluation. For this reason, in some university hospitals, plastic surgeons in training might perform these evaluations. To assess the validity of digital dermoscopy conducted by plastic surgery registrars, the authors collected the diagnoses of excised lesions from a dermoscopy outpatient clinic, comparing results with literature.

METHODS

A total of 1094 consecutive dermoscopy evaluations performed at Padova University Hospital between 2015 and 2018 were included in the study. All examinations were carried out by 3 plastic surgery registrars who received comparable training on dermoscopy. Excised lesions were classified according to pathological reports.

RESULTS

Four hundred sixty-six lesions were excised, and of them, 224 (48%) were considered pathological or atypical lesions: 34 melanomas (15%), 83 dysplastic or uncertain significance nevi (37%), and 107 NMSC and their precursors (48%). Considering only the 347 pigmented lesions, 34% were malignant or dysplastic lesions. The number needed to treat (NNT) was 10. The nevi-to-melanoma ratio (NMR) was 8, and the malignant melanoma-to-melanoma in situ ratio (MM:MMIS ratio) was 0.36.

CONCLUSIONS

This retrospective study tested the performance of specifically trained plastic surgery registrars in the detection of malignant skin lesions. Compared to literature, the analysis reflects a good sensibility for melanoma, especially in early curable stages. Moreover, our study underlines quite a high number of total excisions, which could be explained by the "surgical imprinting" of plastic surgery registrars.