Training primary care providers (PCP) to detect early melanoma led to increased melanoma diagnoses, but had little impact on skin surgeries or dermatology visits. This study of more than 1000 melanoma screenings by primary care providers in western Pennsylvania indicates that this training complies with the old medical maxim to “first do no harm.”1
Malignant melanoma results in approximately 10,000 deaths each year in the United States, but the disease can be cured if caught early. So, some experts have called for widespread training of primary care providers to conduct screenings at routine visits, while others have worried that those screenings could lead to rampant overtreatment and unnecessary patient distress, such as if benign lesions are mistaken for serious cancers.
To address these questions, a team of researchers studied what happened when a cadre of primary care providers in the University of Pittsburgh Medical Center system gained online training in melanoma screening and began looking for the skin cancers in 2014. The training used was the freely available online course INFORMED, which was developed by the lead researchers in 2010.
The analysis involved reviewing data from tens of thousands of encounters with patients age 35 years and older both in the first 8 months of 2013 (before the training occurred) and 2014 (after the training occurred). The researchers also divided care providers into 3 comparison groups: in 1 group, approximately one-quarter of the providers were trained; in the second group, only 1 in 11 of providers were trained; and the third group, no providers were trained. The study design therefore allowed the team to compare several outcomes both over time and across groups with different degrees of training.
Neither dermatologist visits nor skin surgeries substantially increased between 2013 and 2014 in any of the 3 groups. The frequency of these outcomes had little difference between the groups.
However, the providers with the most training did produce a 79% increase in per-patient melanoma diagnoses, while those with less or no training had no significant increase in diagnoses. Notably, the number of diagnoses was tiny (24 of 11,238 patients in 2013 and 48 of 12,560 patients in 2014), and so these did not lead to obvious increases in dermatologist visits or surgeries.
In other words, patients with newly diagnosed melanoma could well have received the proper follow-up care their diagnoses warranted without radically changing the overall number of dermatologist visits or surgeries. But in the meantime, the researchers wrote, there was no sign that training primary care providers to screen for melanoma had flooded dermatologists or surgeons with torrents of cases.
“The early evidence from this screening effort indicates that melanoma screening coupled with a modified INFORMED training program neither results in large numbers of skin surgeries nor a dramatic increase in visits to dermatologists, which are two potential adverse downstream consequences that have been of concern as a potential basis of morbidity, distress, and costs,” the authors wrote.
1. Weinstock MA, Ferris LK, Saul MI, et al. Downstream consequences of melanoma screening in a community practice setting: first results. Cancer. 2016 Jul 8. doi:10.1002/cncr.30177. [Epub ahead of print]