A Primary Care Intervention to Improve Melanoma Detection and Management

The incidence of cutaneous melanoma is increasing while access to dermatology care remains limited. Primary care clinicians are poised to identify and triage melanomas. However, barriers exist, including clinician knowledge and confidence. We tested the feasibility of an educational intervention to improve melanoma identification and management in primary care.

We conducted a mixed-methods pilot feasibility study in two Pacific Northwest primary care clinics caring for underserved populations. Clinicians were invited to participate in educational sessions on skin cancer screening and dermoscopy device use. Qualitative interviews with participating clinicians assessed training experiences. Outcomes measured intervention feasibility, knowledge scores, use of dermatology e-consults, referrals and biopsy rates.

Clinicians exposed to the training (n=15) had significant gains in overall knowledge, with primary improvement in lesion identification and biopsy literacy. Referrals for in-person dermatology evaluation significantly decreased for the training-exposed clinicians (16.9 vs. 11.4 per 1000 visits pre, post respectively) whereas the comparison group (n=29) had a small increase (13.8 vs. 14.0 per 1000 visits). General skin check referrals decreased for the exposed group and increased for the comparison group, (p<0.01). Lesion-specific e-consults increased more in the intervention group but did not reach significance (p=0.05). Biopsy rates did not differ significantly. Qualitative findings highlighted training utility, especially image identification review and dermoscopy use.

Melanoma education increased the specificity of primary care clinicians' e-consults without increasing in-person dermatology referrals or unnecessary biopsies. While this intervention has promise for improving skin cancer care in primary care, efforts are needed to increase clinician engagement in this education.