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Training in basic skin cancer triage can improve primary care providers' practice of skin cancer control measures

The incidence of melanoma, a deadly form of skin cancer, and deaths associated with it have increased over the past few decades. The average American makes 1.7 visits to a primary care provider (PCP) each year, offering an opportunity to prevent skin cancer. Early detection of skin cancer by PCPs has been limited in the past by low confidence and lack of training. Training in basic skin cancer triage (BSCT) may increase the practice of skin cancer control measures by PCP, concludes a study supported in part by the Agency for Healthcare Research and Quality (National Research Service Award training grant T32 HS00011).

The researchers used pre- and post-training surveys to examine how a 2-hour BSCT curriculum influenced skin examination, skin cancer counseling attitudes, and skin cancer control practices of 22 PCPs. The BSCT curriculum was designed to increase the ability of PCPs to accurately and confidently identify skin lesions and to counsel patients on skin cancer issues. Each PCP received a packet containing the lecture outline, triage algorithm, skin cancer information pamphlets, and review articles. The lecture emphasized skin cancer epidemiology, clinical characteristics and diagnosis, and prevention and counseling approaches.

Following BSCT training, providers were more likely to agree about the importance of conducting total body skin exams (TBSEs), moving from 4.20 to 4.60 on a 5-point scale (with 5 being most agreement). Agreement about the importance of skin cancer prevention counseling improved only slightly (from 4.09 to 4.22). Providers also reported an increase in the practice of skin cancer control measures (for example, performing TBSEs, asking about sun protection behavior, counseling about skin cancer risk, and providing information about skin cancer) both during an initial patient visit (from 2.17 to 3.21) and routine visits with patients at high risk for melanoma (2.15 to 3.00). Patient exit interviews confirmed these changes in practice patterns.

For more details, see "Impact of the basic skin cancer triage curriculum on providers' skin cancer control practices," by Radha Mikkilineni, M.D., M.Sc., Martin A. Weinstock, M.D., Ph.D., Michael G. Goldstein, M.D., and others, in the May 2001 Journal of General Internal Medicine 16, pp. 302-307.

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