Skin cancer screening in the primary care setting
Lewandowski, Emily Elizabeth
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INTRODUCTION: Skin cancer is the most common cancer in the United States and melanoma is the fifth most common kind of cancer. The incidence of melanoma has been increasing over the past thirty years. This type of cancer can be detected using a visual skin examination. Survival is related to the thinness and stage at the time of diagnosis. Clinicians find thinner, earlier stage melanomas compared to those found by patients and significant others. REVIEW OF THE LITERATURE: The average American visits their primary care provider twice annually and skin conditions are the number one reason Americans younger than sixty-five visit their primary care physician. However, the majority of residents in the United States are not comfortable with performing the full body skin examination required to screen for melanoma. Medical schools in the United States spend one percent of the curriculum on dermatologic conditions. In fact, the United States Preventative Services Task Force does not support regular skin cancer screening by primary care providers since there is limited evidence that primary care physicians perform adequate skin examinations. METHODS: This curriculum is aimed at teaching internal medicine and family medicine interns and primary care physician assistants and nurse practitioners the full body skin cancer screening examination as well as the ability to differentiate between benign and malignant skin lesions. A pre- and post-course examination of benign versus malignant lesions will be distributed and the scores will be analyzed using a paired T-test. A pre- and post-course Likert scale will be dispersed to evaluate how clinical practice changes based on this course. Mean and standard deviation for the overall Likert scale as well as individual parts of the scale will be calculated and a paired T-test will be used to analyze how the course changed clinical practice of the clinicians. Additionally, standardized patients will be provided for the participants to practice the full body skin examination. CONCLUSION: This study is unique in that it is teaching primary care medical interns as well as physician assistants and nurse practitioners the full body skin examination. Limitations include a small sample size, voluntary participation in the setting of a busy work schedule, and pushback from clinicians since performing full body skin exams are not recommended at this time.