Skin Cancer Screening: Implementation of Dermoscopy in Rural Primary Care

Skin cancer is the most common cancer in the United States and worldwide, and rates continue to rise (American Academy of Dermatology Association [AAD], 2020; Skin Cancer Foundation [SCF], 2020). Although there is disagreement about the reasons why, rural areas are more dramatically affected by skin cancer morbidity and mortality than their urban counterparts (Cunningham et al., 2019). Early detection of all skin cancers, especially melanoma, can improve morbidity and mortality rates (Hubner et al., 2018; Kricker et al., 2014). Secondary prevention strategies, such as naked eye skin examinations and dermsocopy, are critical in monitoring and identifying suspicious skin lesions. The results of naked eye examinations are often inconsistent because of varying clinician competence, confidence level, and time. When performed correctly and in adjunct with the naked eye examination, dermoscopy is more sensitive and specific at classifying skin lesions than naked eye examinations alone and use could help lead to the earlier diagnosis of cancerous skin lesions (Chappuis et al., 2016). However, many primary care clinicians do not have the skills or resources to use dermoscopy effectively. Dermoscopy training programs have increased skin lesion diagnostic accuracy and confidence among primary care clinicians, even in as little as a one-day seminar (Augustsson & Paoli, 2019). Because of this, an education seminar was implemented at a federally funded institution that provides primary care to rural residents of eastern North Dakota, western Minnesota, and northeastern South Dakota. The purpose of this practice improvement project was to improve overall care quality and skin cancer survival rates in rural areas through early and accurate detection by educating primary care clinicians on the use of dermoscopy. Pre- and post-implementation surveys were used to compare clinician knowledge of skin cancer, dermoscopy algorithms, opinions on the usefulness of dermoscopy, and comfortability with the practice of dermoscopy. Following the educational seminar, a three-month implementation period provided time for providers to implement their knowledge and dermoscopy skills in practice. Results of the surveys showed an increase in clinician comfortability and knowledge regarding dermoscopy use after the education seminar as opposed to before