Expert Consensus Statement on Proficiency Standards for Dermoscopy Education in Primary Care

doi:10.3122/jabfm.2022.220143R1

. 2023 Feb 8;36(1):25-38.

doi: 10.3122/jabfm.2022.220143R1.

Expert Consensus Statement on Proficiency Standards for Dermoscopy Education in Primary Care

Tiffaney Tran¹, Peggy R Cyr¹, Alex Verdieck¹, Miranda D Lu¹, Hadjh T Ahrns¹, Elizabeth G Berry¹, William Bowen¹, Ralph P Braun¹, Joshua M Cusick-Lewis¹, Hung Q Doan¹, Valerie L Donohue¹, Deborah R Erlich¹, Laura K Ferris¹, Evelyne Harkemanne¹, Rebecca I Hartman¹, James Holt¹, Natalia Jaimes¹, Timothy A Joslin¹, Zhyldyz Kabaeva¹, Tracey N Liebman¹, Joanna Ludzik¹, Ashfaq A Marghoob¹, Isac Simpson¹, Jennifer A Stein¹, Daniel L Stulberg¹, Isabelle Tromme¹, Matthew J Turnquist¹, Richard P Usatine¹, Alison M Walker¹, Bryan L Walker¹, Robert F West¹, Megan L Wilson¹, Alexander Witkowski¹, Dominic J Wu¹, Elizabeth V Seiverling¹, Kelly C Nelson²

Affiliations

¹ From the Department of Dermatology, The University of Texas MD Anderson Cancer Center, Houston (TT, HQD, KCN); Department of Family Medicine, Maine Medical Center, Portland (PRC, HTA); Department of Family Medicine, Tufts University School of Medicine, Boston, MA (PRC, DRE); Department of Family Medicine, Oregon Health & Science University School of Medicine, Portland (AV, TAJ); Swedish First Hill Family Medicine Residency, Seattle, WA (MDL); Department of Dermatology, Oregon Health & Science University School of Medicine, Portland (EGB, JL, AW); Christus St. Vincent Family Medicine Center, Sante Fe, NM (WB); Department of Dermatology, University Hospital of Zürich, University of Zürich, Zürich, Switzerland (RPB); Cabin Creek Health Systems, Dawes, WV (JMC-L); Lincoln Medical Partners, Damariscotta, ME (VLD); Department of Dermatology, University of Pittsburgh Medical Center, Pittsburgh, PA (LKF); Dermatology Department, Cliniques Universitaires Saint-Luc, Brussels, Belgium (EH); Institute of Experimental & Clinical Research, Université Catholique de Louvain, Brussels, Belgium (EH); Department of Dermatology, Brigham and Women's Hospital, Boston, MA (RIH); Melanoma Program, Dana-Farber Cancer Institute, Boston, MA (RIH); Veterans Integrated Services Network, Jamaica Plain, MA (RIH); Department of Family Medicine, East Tennessee State University James H. Quillen College of Medicine, Johnson City, TN (JH); Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, FL (NJ); Sylvester Comprehensive Cancer Center, Miami, FL (NJ); Department of Internal Medicine, Maine Medical Center, Cape Elizabeth, ME (ZK); The Ronald O. Perelman Department of Dermatology, New York University Grossman School of Medicine, New York (TNL, JAS); Department of Telemedicine and Bioinformatics, Jagiellonian University Medical College, Krakow, Poland (JL); Dermatology Service, Memorial Sloan Kettering Cancer Center, New York, NY (AAM); Simpson DermCare & Family Medicine, Ammon, ID (IS); Department of Family & Community Medicine, University of New Mexico School of Medicine, Albuquerque (DLS); Dermatology Department, King Albert II Cancer and Hematology Institute, Cliniques Universitaires Saint-Luc, Brussels, Belgium (IT); Department of Family Medicine, Millinocket Regional Hospital, Millinocket, ME (MJT); Western Maine Primary Care, Norway (MJT); Department of Dermatology & Cutaneous Surgery, Department of Family & Community Medicine, The University of Texas Health Science Center at San Antonio, San Antonio, TX (RPU); Brigham and Women's Health Care Center, Pembroke, MA (AMW); South Shore Medical Center, Norwell, MA (BLW); Redirect Health, Glendale, AZ (RFW); Department of Family Medicine, University of Washington School of Medicine, Seattle (MLW); Department of Dermatology, University of Kansas Medical Center, Kansas City (DJW); Division of Dermatology, Maine Medical Center, Portland (EVS); Department of Dermatology, Tufts University School of Medicine, Boston, MA (EVS).
² From the Department of Dermatology, The University of Texas MD Anderson Cancer Center, Houston (TT, HQD, KCN); Department of Family Medicine, Maine Medical Center, Portland (PRC, HTA); Department of Family Medicine, Tufts University School of Medicine, Boston, MA (PRC, DRE); Department of Family Medicine, Oregon Health & Science University School of Medicine, Portland (AV, TAJ); Swedish First Hill Family Medicine Residency, Seattle, WA (MDL); Department of Dermatology, Oregon Health & Science University School of Medicine, Portland (EGB, JL, AW); Christus St. Vincent Family Medicine Center, Sante Fe, NM (WB); Department of Dermatology, University Hospital of Zürich, University of Zürich, Zürich, Switzerland (RPB); Cabin Creek Health Systems, Dawes, WV (JMC-L); Lincoln Medical Partners, Damariscotta, ME (VLD); Department of Dermatology, University of Pittsburgh Medical Center, Pittsburgh, PA (LKF); Dermatology Department, Cliniques Universitaires Saint-Luc, Brussels, Belgium (EH); Institute of Experimental & Clinical Research, Université Catholique de Louvain, Brussels, Belgium (EH); Department of Dermatology, Brigham and Women's Hospital, Boston, MA (RIH); Melanoma Program, Dana-Farber Cancer Institute, Boston, MA (RIH); Veterans Integrated Services Network, Jamaica Plain, MA (RIH); Department of Family Medicine, East Tennessee State University James H. Quillen College of Medicine, Johnson City, TN (JH); Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, FL (NJ); Sylvester Comprehensive Cancer Center, Miami, FL (NJ); Department of Internal Medicine, Maine Medical Center, Cape Elizabeth, ME (ZK); The Ronald O. Perelman Department of Dermatology, New York University Grossman School of Medicine, New York (TNL, JAS); Department of Telemedicine and Bioinformatics, Jagiellonian University Medical College, Krakow, Poland (JL); Dermatology Service, Memorial Sloan Kettering Cancer Center, New York, NY (AAM); Simpson DermCare & Family Medicine, Ammon, ID (IS); Department of Family & Community Medicine, University of New Mexico School of Medicine, Albuquerque (DLS); Dermatology Department, King Albert II Cancer and Hematology Institute, Cliniques Universitaires Saint-Luc, Brussels, Belgium (IT); Department of Family Medicine, Millinocket Regional Hospital, Millinocket, ME (MJT); Western Maine Primary Care, Norway (MJT); Department of Dermatology & Cutaneous Surgery, Department of Family & Community Medicine, The University of Texas Health Science Center at San Antonio, San Antonio, TX (RPU); Brigham and Women's Health Care Center, Pembroke, MA (AMW); South Shore Medical Center, Norwell, MA (BLW); Redirect Health, Glendale, AZ (RFW); Department of Family Medicine, University of Washington School of Medicine, Seattle (MLW); Department of Dermatology, University of Kansas Medical Center, Kansas City (DJW); Division of Dermatology, Maine Medical Center, Portland (EVS); Department of Dermatology, Tufts University School of Medicine, Boston, MA (EVS) kcnelson1@mdanderson.org.

PMID: 36759132
PMCID: PMC10961604
DOI: 10.3122/jabfm.2022.220143R1

Expert Consensus Statement on Proficiency Standards for Dermoscopy Education in Primary Care

Tiffaney Tran et al. J Am Board Fam Med. 2023.

. 2023 Feb 8;36(1):25-38.

doi: 10.3122/jabfm.2022.220143R1.

Authors

Affiliations

¹ From the Department of Dermatology, The University of Texas MD Anderson Cancer Center, Houston (TT, HQD, KCN); Department of Family Medicine, Maine Medical Center, Portland (PRC, HTA); Department of Family Medicine, Tufts University School of Medicine, Boston, MA (PRC, DRE); Department of Family Medicine, Oregon Health & Science University School of Medicine, Portland (AV, TAJ); Swedish First Hill Family Medicine Residency, Seattle, WA (MDL); Department of Dermatology, Oregon Health & Science University School of Medicine, Portland (EGB, JL, AW); Christus St. Vincent Family Medicine Center, Sante Fe, NM (WB); Department of Dermatology, University Hospital of Zürich, University of Zürich, Zürich, Switzerland (RPB); Cabin Creek Health Systems, Dawes, WV (JMC-L); Lincoln Medical Partners, Damariscotta, ME (VLD); Department of Dermatology, University of Pittsburgh Medical Center, Pittsburgh, PA (LKF); Dermatology Department, Cliniques Universitaires Saint-Luc, Brussels, Belgium (EH); Institute of Experimental & Clinical Research, Université Catholique de Louvain, Brussels, Belgium (EH); Department of Dermatology, Brigham and Women's Hospital, Boston, MA (RIH); Melanoma Program, Dana-Farber Cancer Institute, Boston, MA (RIH); Veterans Integrated Services Network, Jamaica Plain, MA (RIH); Department of Family Medicine, East Tennessee State University James H. Quillen College of Medicine, Johnson City, TN (JH); Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, FL (NJ); Sylvester Comprehensive Cancer Center, Miami, FL (NJ); Department of Internal Medicine, Maine Medical Center, Cape Elizabeth, ME (ZK); The Ronald O. Perelman Department of Dermatology, New York University Grossman School of Medicine, New York (TNL, JAS); Department of Telemedicine and Bioinformatics, Jagiellonian University Medical College, Krakow, Poland (JL); Dermatology Service, Memorial Sloan Kettering Cancer Center, New York, NY (AAM); Simpson DermCare & Family Medicine, Ammon, ID (IS); Department of Family & Community Medicine, University of New Mexico School of Medicine, Albuquerque (DLS); Dermatology Department, King Albert II Cancer and Hematology Institute, Cliniques Universitaires Saint-Luc, Brussels, Belgium (IT); Department of Family Medicine, Millinocket Regional Hospital, Millinocket, ME (MJT); Western Maine Primary Care, Norway (MJT); Department of Dermatology & Cutaneous Surgery, Department of Family & Community Medicine, The University of Texas Health Science Center at San Antonio, San Antonio, TX (RPU); Brigham and Women's Health Care Center, Pembroke, MA (AMW); South Shore Medical Center, Norwell, MA (BLW); Redirect Health, Glendale, AZ (RFW); Department of Family Medicine, University of Washington School of Medicine, Seattle (MLW); Department of Dermatology, University of Kansas Medical Center, Kansas City (DJW); Division of Dermatology, Maine Medical Center, Portland (EVS); Department of Dermatology, Tufts University School of Medicine, Boston, MA (EVS).
² From the Department of Dermatology, The University of Texas MD Anderson Cancer Center, Houston (TT, HQD, KCN); Department of Family Medicine, Maine Medical Center, Portland (PRC, HTA); Department of Family Medicine, Tufts University School of Medicine, Boston, MA (PRC, DRE); Department of Family Medicine, Oregon Health & Science University School of Medicine, Portland (AV, TAJ); Swedish First Hill Family Medicine Residency, Seattle, WA (MDL); Department of Dermatology, Oregon Health & Science University School of Medicine, Portland (EGB, JL, AW); Christus St. Vincent Family Medicine Center, Sante Fe, NM (WB); Department of Dermatology, University Hospital of Zürich, University of Zürich, Zürich, Switzerland (RPB); Cabin Creek Health Systems, Dawes, WV (JMC-L); Lincoln Medical Partners, Damariscotta, ME (VLD); Department of Dermatology, University of Pittsburgh Medical Center, Pittsburgh, PA (LKF); Dermatology Department, Cliniques Universitaires Saint-Luc, Brussels, Belgium (EH); Institute of Experimental & Clinical Research, Université Catholique de Louvain, Brussels, Belgium (EH); Department of Dermatology, Brigham and Women's Hospital, Boston, MA (RIH); Melanoma Program, Dana-Farber Cancer Institute, Boston, MA (RIH); Veterans Integrated Services Network, Jamaica Plain, MA (RIH); Department of Family Medicine, East Tennessee State University James H. Quillen College of Medicine, Johnson City, TN (JH); Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, FL (NJ); Sylvester Comprehensive Cancer Center, Miami, FL (NJ); Department of Internal Medicine, Maine Medical Center, Cape Elizabeth, ME (ZK); The Ronald O. Perelman Department of Dermatology, New York University Grossman School of Medicine, New York (TNL, JAS); Department of Telemedicine and Bioinformatics, Jagiellonian University Medical College, Krakow, Poland (JL); Dermatology Service, Memorial Sloan Kettering Cancer Center, New York, NY (AAM); Simpson DermCare & Family Medicine, Ammon, ID (IS); Department of Family & Community Medicine, University of New Mexico School of Medicine, Albuquerque (DLS); Dermatology Department, King Albert II Cancer and Hematology Institute, Cliniques Universitaires Saint-Luc, Brussels, Belgium (IT); Department of Family Medicine, Millinocket Regional Hospital, Millinocket, ME (MJT); Western Maine Primary Care, Norway (MJT); Department of Dermatology & Cutaneous Surgery, Department of Family & Community Medicine, The University of Texas Health Science Center at San Antonio, San Antonio, TX (RPU); Brigham and Women's Health Care Center, Pembroke, MA (AMW); South Shore Medical Center, Norwell, MA (BLW); Redirect Health, Glendale, AZ (RFW); Department of Family Medicine, University of Washington School of Medicine, Seattle (MLW); Department of Dermatology, University of Kansas Medical Center, Kansas City (DJW); Division of Dermatology, Maine Medical Center, Portland (EVS); Department of Dermatology, Tufts University School of Medicine, Boston, MA (EVS) kcnelson1@mdanderson.org.

PMID: 36759132
PMCID: PMC10961604
DOI: 10.3122/jabfm.2022.220143R1

Abstract

Background: Primary care providers (PCPs) frequently address dermatologic concerns and perform skin examinations during clinical encounters. For PCPs who evaluate concerning skin lesions, dermoscopy (a noninvasive skin visualization technique) has been shown to increase the sensitivity for skin cancer diagnosis compared with unassisted clinical examinations. Because no formal consensus existed on the fundamental knowledge and skills that PCPs should have with respect to dermoscopy for skin cancer detection, the objective of this study was to develop an expert consensus statement on proficiency standards for PCPs learning or using dermoscopy.

Methods: A 2-phase modified Delphi method was used to develop 2 proficiency standards. In the study's first phase, a focus group of PCPs and dermatologists generated a list of dermoscopic diagnoses and associated features. In the second phase, a larger panel evaluated the proposed list and determined whether each diagnosis was reflective of a foundational or intermediate proficiency or neither.

Results: Of the 35 initial panelists, 5 PCPs were lost to follow-up or withdrew; 30 completed the fifth and last round. The final consensus-based list contained 39 dermoscopic diagnoses and associated features.

Conclusions: This consensus statement will inform the development of PCP-targeted dermoscopy training initiatives designed to support early cancer detection.

Keywords: Continuing Medical Education; Delphi Method; Dermoscopy; Expert Opinion; Focus Groups; General Practitioners; Melanoma; Primary Care Physicians; Primary Health Care; Skin Cancer.

PubMed Disclaimer

Conflict of interest statement

Conflict of interest: None.

Figures

**Figure 1.**
Consensus process using a 2-phase modified Delphi method.

See this image and copyright information in PMC

Comment in

Re: Expert Consensus Statement on Proficiency Standards for Dermoscopy Education in Primary Care.
Blum A. Blum A. J Am Board Fam Med. 2023 Aug 9;36(4):695. doi: 10.3122/jabfm.2023.230138R0. J Am Board Fam Med. 2023. PMID: 37562835 No abstract available.

Cited by

Impact of Dermoscopy Training on Diagnostic Accuracy, and Its Association With Biopsy and Referral Patterns Among Primary Care Providers: A Retrospective and Prospective Educational Intervention Study.
Middleton HT, Swanson DL, Sartori-Valinotti JC, O'Laughlin DJ, Young PA, Merry SP, Nelson K, Fischer K, Weatherly RM, Boswell CL. Middleton HT, et al. J Prim Care Community Health. 2024 Jan-Dec;15:21501319241296625. doi: 10.1177/21501319241296625. J Prim Care Community Health. 2024. PMID: 39498620 Free PMC article.
Clinical Utility of a Digital Dermoscopy Image-Based Artificial Intelligence Device in the Diagnosis and Management of Skin Cancer by Dermatologists.
Witkowski AM, Burshtein J, Christopher M, Cockerell C, Correa L, Cotter D, Ellis DL, Farberg AS, Grant-Kels JM, Greiling TM, Grichnik JM, Leachman SA, Linfante A, Marghoob A, Marks E, Nguyen K, Ortega-Loayza AG, Paragh G, Pellacani G, Rabinovitz H, Rigel D, Siegel DM, Song EJ, Swanson D, Trask D, Ludzik J. Witkowski AM, et al. Cancers (Basel). 2024 Oct 24;16(21):3592. doi: 10.3390/cancers16213592. Cancers (Basel). 2024. PMID: 39518033 Free PMC article.
Skin Cancer Diagnosis by Lesion, Physician, and Examination Type: A Systematic Review and Meta-Analysis.
Chen JY, Fernandez K, Fadadu RP, Reddy R, Kim MO, Tan J, Wei ML. Chen JY, et al. JAMA Dermatol. 2025 Feb 1;161(2):135-146. doi: 10.1001/jamadermatol.2024.4382. JAMA Dermatol. 2025. PMID: 39535756
Oregon primary care providers as a frontline defense in the War on Melanoma™: improving access to melanoma education.
Becker AL, Nelson JH, Verdieck-Devlaeminck A, Berry EG, Orfaly VE, Stoos ER, Tran J, Latour E, Sahni VN, Xu S, Babcock M, Bar A, Becevic M, Chan C, Chisholm D, Diehl K, Edison K, Ferris LK, Foltz EA, Geller AC, Jacobe H, Johnson MM, Kinghorn P, Leitenberger J, Ludzik J, McClanahan D, Mengden-Koon S, Nelson K, Petering R, Prasad S, Roscher A, Savory S, Smith EH, Swetter SM, Tofte S, Weinstock MA, White K, Wisco O, Witkowski A, Leachman SA. Becker AL, et al. Front Med (Lausanne). 2025 Mar 14;12:1427136. doi: 10.3389/fmed.2025.1427136. eCollection 2025. Front Med (Lausanne). 2025. PMID: 40160331 Free PMC article.

References

1. Siegel RL, Miller KD, Fuchs HE, Jemal A. Cancer statistics, 2022. CA A Cancer J Clinicians 2022;72: 7–33. - PubMed
1. Howlader NN, Krapcho M, Miller D, et al. editors. SEER cancer statistics review, 1975–2016 [Internet].2019. [cited 2021 July 1]. Available from: https://seer.cancer.gov/csr/1975_2016/.
1. Glazer AM, Farberg AS, Winkelmann RR, Rigel DS. Analysis of trends in geographic distribution and density of US dermatologists. JAMA Dermatol 2017;153:322–5. - PubMed
1. Vaidya T, Zubritsky L, Alikhan A, Housholder A. Socioeconomic and geographic barriers to dermatology care in urban and rural US populations. J Am Acad Dermatol 2018;78:406–8. - PubMed
1. Wu X, Marchetti MA, Marghoob AA. Dermoscopy: not just for dermatologists. Melanoma Manag 2015; 2:63–73. - PMC - PubMed

Publication types

Actions

MeSH terms

Actions
Actions
Actions
Actions
Actions
Actions
Actions

Grants and funding

P30 CA008748/CA/NCI NIH HHS/United States

LinkOut - more resources

Full Text Sources
Medical
- MedlinePlus Health Information

[1] Siegel RL, Miller KD, Fuchs HE, Jemal A. Cancer statistics, 2022. CA A Cancer J Clinicians 2022;72: 7–33. - PubMed

[2] Siegel RL, Miller KD, Fuchs HE, Jemal A. Cancer statistics, 2022. CA A Cancer J Clinicians 2022;72: 7–33. - PubMed

[3] Howlader NN, Krapcho M, Miller D, et al. editors. SEER cancer statistics review, 1975–2016 [Internet].2019. [cited 2021 July 1]. Available from: https://seer.cancer.gov/csr/1975_2016/.

[4] Howlader NN, Krapcho M, Miller D, et al. editors. SEER cancer statistics review, 1975–2016 [Internet].2019. [cited 2021 July 1]. Available from: https://seer.cancer.gov/csr/1975_2016/.

[5] Glazer AM, Farberg AS, Winkelmann RR, Rigel DS. Analysis of trends in geographic distribution and density of US dermatologists. JAMA Dermatol 2017;153:322–5. - PubMed

[6] Glazer AM, Farberg AS, Winkelmann RR, Rigel DS. Analysis of trends in geographic distribution and density of US dermatologists. JAMA Dermatol 2017;153:322–5. - PubMed

[7] Vaidya T, Zubritsky L, Alikhan A, Housholder A. Socioeconomic and geographic barriers to dermatology care in urban and rural US populations. J Am Acad Dermatol 2018;78:406–8. - PubMed

[8] Vaidya T, Zubritsky L, Alikhan A, Housholder A. Socioeconomic and geographic barriers to dermatology care in urban and rural US populations. J Am Acad Dermatol 2018;78:406–8. - PubMed

[9] Wu X, Marchetti MA, Marghoob AA. Dermoscopy: not just for dermatologists. Melanoma Manag 2015; 2:63–73. - PMC - PubMed

[10] Wu X, Marchetti MA, Marghoob AA. Dermoscopy: not just for dermatologists. Melanoma Manag 2015; 2:63–73. - PMC - PubMed

Save citation to file

Email citation

Add to Collections

Add to My Bibliography

Your saved search

Create a file for external citation management software

Your RSS Feed

Expert Consensus Statement on Proficiency Standards for Dermoscopy Education in Primary Care

Affiliations

Expert Consensus Statement on Proficiency Standards for Dermoscopy Education in Primary Care

Authors

Affiliations

Abstract

Conflict of interest statement

Figures

Comment in

Similar articles

Cited by

References

Publication types

MeSH terms

Grants and funding

LinkOut - more resources

Full Text Sources

Medical