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. 2019 Jan-Feb;32(1):96-102.
doi: 10.3122/jabfm.2019.01.180049.

Teaching Benign Skin Lesions as a Strategy to Improve the Triage Amalgamated Dermoscopic Algorithm (TADA)

Elizabeth V Seiverling  1 , Hadjh T Ahrns  2 , Amrit Greene  2 , Melissa Butt  2 , Oriol Yélamos  2 , Stephen W Dusza  2 , Ashfaq A Marghoob  2
Affiliations

Teaching Benign Skin Lesions as a Strategy to Improve the Triage Amalgamated Dermoscopic Algorithm (TADA)

Elizabeth V Seiverling et al. J Am Board Fam Med. 2019 Jan-Feb.

Abstract

Introduction: Dermoscopy aids family physicians (FPs) in skin cancer detection. The triage amalgamated dermoscopic algorithm (TADA) was created to simplify the dermoscopic evaluation of a skin growth. The purpose of this image-based study was to evaluate the effect of teaching the clinical and dermoscopic features of benign skin lesions on the diagnostic accuracy of skin cancer identification using TADA. We also sought to determine the best method to teach benign neoplasms.

Methods: In this cross-sectional study of an educational intervention, FPs participated in dermoscopy training. Participants were divided into 3 groups for teaching of common benign neoplasms (dermatofibroma, angioma, and seborrheic keratosis/lentigo): didactic + interactive, didactic + heuristic, and didactic. For each group, the benign teaching was followed by skin cancer identification training with TADA. All participants took a 30 image pre-test and 30 image post-test.

Results: Fifty-nine participants completed the study. The mean preintervention score (out of 30 correct responses) was 17.9 (SD, 4.5) and increased to 23.5 (SD, 3.0) on the postintervention evaluation (P < .001). Sensitivity for skin cancer increased from 62.5% to 88.1% following the intervention. Postintervention specificity for skin cancer was 87.8%. Sensitivity and specificity increased following the intervention for all 3 types of benign neoplasms. Diagnostic accuracy was not impacted by the method of benign teaching.

Conclusion: Short dermoscopy training sessions with dedicated time for benign growths followed by TADA training for malignant growths are an effective means of teaching FPs dermoscopy and result in a high sensitivity and specificity for the identification of benign and malignant skin neoplasms.

Keywords: Cross-Sectional Studies; Dermatofibroma; Dermoscopy; Family Physicians; Seborrheic Keratosis; Skin Cancer.

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Conflict of interest statement

Conflict of interest: Dr. Marghoob has served as a consultant for 3GEN, Canfield, and Heine. However, he did not receive support from them for any portion of this research or manuscript. He has received honoraria from 3GEN and is friends with employees at 3GEN and Canfield. He has intellectual passion for dermoscopy. The other authors have no conflicts of interest to disclose.

Figures

Figure 1.
Figure 1.
Study design. Three arms, each with a different educational modality for benign growths, namely dermatofibroma (DF), angioma, and seborrheic keratosis (SK).
Figure 2.
Figure 2.
Common benign skin growths.
Figure 3.
Figure 3.
Dermoscopic findings in malignant skin growths by using the Triage Amalgamated Dermoscopic Algorithm TADA.
Figure 4.
Figure 4.
Boxplot of preintervention and postintervention scores.
Figure 5.
Figure 5.
Sensitivity preintervention and postintervention for common benign skin growths and skin cancer. DF, dermatofibroma; SK, seborrheic keratosis.
See this image and copyright information in PMC

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