A free online education program improved primary care clinicians' ability to identify potential melanomas. Researchers evaluated outcomes from the Melanoma Toolkit for Early Detection, which aims to address the shortage of dermatologists by training primary care providers in skin cancer screening.
After completing the training, clinicians showed significant improvements in identifying malignant and benign skin lesions. Participant confidence in melanoma identification also increased substantially, rising by an average of 2.1 points on a 10-point scale (95% CI: 1.6-2.6; P < 0.001), according to the study in Frontiers in Medicine.
"PCPs may serve as a valuable aid in skin cancer screening efforts," wrote lead author Kyra Diehl, MD, and colleagues from the Oregon Health and Science University. However, they noted that "additional studies are needed to evaluate the impact of these curricula in clinical practice."
Between 2019 and 2024, the toolkit was accessed by 8,683 unique users, with 139 participants completing pre-training surveys and 92 completing post-training assessments. The study analyzed data from 55 matched participants who completed both components.
The curriculum addresses a critical health care gap, as there are approximately 8,905 primary care providers but only 235 dermatologists in Oregon, a ratio of 38:1. The toolkit includes six modules covering patient risk identification, rapid screening techniques, visual lesion identification, biopsy instruction, solutions for busy clinics, and patient education resources.
The program improved provider knowledge about melanoma in patients with skin of color. Post-training, there was a 36.9% increase in clinicians reporting adequate education about melanoma in patients with skin of color.
However, the study revealed ongoing challenges. After training, more providers identified time constraints as a barrier to performing skin exams (72.7% post-training vs. 41.8% pre-training, P < 0.001). Additionally, 78.8% of clinicians reported they "never" or only "sometimes" have patients change into gowns for skin examinations.
"The flexible 'toolkit' design of our web-based resources allowed participants to engage in the content most relevant to their pre-existing knowledge base," the researchers wrote. "A systematic review on PCP skin cancer education programs found that the interventions that were successful in effecting behavior change used online interactive formats, while unsuccessful interventions were brief and passive."
The study team acknowledged several limitations, including the small sample size of matched pre-post survey participants and potential selection bias toward highly motivated clinicians. They also noted that the modest improvements in lesion identification might reflect the deliberately challenging nature of the test images, which included indeterminate cases to simulate real-world conditions.
The researchers emphasized the need for longitudinal studies to evaluate the program's effects on clinical behavior changes and patient outcomes. This data would help validate the broader efficacy of the curriculum in improving early melanoma detection rates.
Research was supported by the Knight Cancer Institute at Oregon Health & Science University, though specific funding details were not disclosed. The authors declared having no competing interests.
