Instructional Strategies to Enhance Dermoscopic Image Interpretation Education: a Review of the Literature
Tran, Tiffaney; Ternov, Niels K; Weber, Jochen; Barata, Catarina; Berry, Elizabeth G; Doan, Hung Q; Marghoob, Ashfaq A; Seiverling, Elizabeth V; Sinclair, Shelly; Stein, Jennifer A; Stoos, Elizabeth R; Tolsgaard, Martin G; Wolfensperger, Maya; Braun, Ralph P; Nelson, Kelly C
INTRODUCTION/UNASSIGNED:In image interpretation education, many educators have shifted away from traditional methods that involve passive instruction and fragmented learning to interactive ones that promote active engagement and integrated knowledge. By training pattern recognition skills in an effective manner, these interactive approaches provide a promising direction for dermoscopy education. OBJECTIVES/UNASSIGNED:A narrative review of the literature was performed to probe emerging directions in medical image interpretation education that may support dermoscopy education. This article represents the second of a two-part review series. METHODS/UNASSIGNED:To promote innovation in dermoscopy education, the International Skin Imaging Collaborative (ISIC) assembled an Education Working Group that comprises international dermoscopy experts and educational scientists. Based on a preliminary literature review and their experiences as educators, the group developed and refined a list of innovative approaches through multiple rounds of discussion and feedback. For each approach, literature searches were performed for relevant articles. RESULTS/UNASSIGNED:Through a consensus-based approach, the group identified a number of theory-based approaches, as discussed in the first part of this series. The group also acknowledged the role of motivation, metacognition, and early failures in optimizing the learning process. Other promising teaching tools included gamification, social media, and perceptual and adaptive learning modules (PALMs). CONCLUSIONS/UNASSIGNED:Over the years, many dermoscopy educators may have intuitively adopted these instructional strategies in response to learner feedback, personal observations, and changes in the learning environment. For dermoscopy training, PALMs may be especially valuable in that they provide immediate feedback and adapt the training schedule to the individual's performance.
To the Editor: Patient and County-Level Factors Associated with Late Stage Merkel Cell Carcinoma at Diagnosis
Shah, Payal; Polsky, David; Shao, Yongzhao; Stein, Jennifer; Liebman, Tracey N
Delays in melanoma presentation during the COVID-19 pandemic: A nationwide multi-institutional cohort study
Trepanowski, Nicole; Chang, Michael S; Zhou, Guohai; Ahmad, Maham; Berry, Elizabeth G; Bui, Katherine; Butler, William H; Chu, Emily Y; Curiel-Lewandrowski, Clara; Dellalana, Laura E; Ellis, Darrel L; Freeman, S Caleb; Gorrepati, Pavane L; Grossman, Douglas; Gyurdzhyan, Samvel; Kanetsky, Peter A; Ong King, Amber Loren; Kolla, Avani M; Lian, Christine G; Lin, Jennifer Y; Liu, Vincent; Lowenthal, Annie; McCoy, Kelly N; Munjal, Ananya; Myrdal, Caitlyn N; Perkins, Sara; Powers, Jennifer G; Rauck, Corinne; Smart, Tristan C; Stein, Jennifer A; Venna, Suraj; Walsh, Madalyn E; Wang, Jennifer Y; Leachman, Sancy A; Swetter, Susan M; Hartman, Rebecca I
A Health Equity Framework to Address Racial and Ethnic Disparities in Melanoma
Kolla, Avani M; Seixas, Azizi; Adotama, Prince; Foster, Victoria; Kwon, Simona; Li, Vivienne; Lee, Ann Y; Stein, Jennifer A; Polsky, David
Theory-Based Approaches to Support Dermoscopic Image Interpretation Education: A Review of the Literature
Tran, Tiffaney; Ternov, Niels K.; Weber, Jochen; Barata, Catarina; Berry, Elizabeth G.; Doan, Hung Q.; Marghoob, Ashfaq A.; Seiverling, Elizabeth V.; Sinclair, Shelly; Stein, Jennifer A.; Stoos, Elizabeth R.; Tolsgaard, Martin G.; Wolfensperger, Maya; Braun, Ralph P.; Nelson, Kelly C.
Introduction: Efficient interpretation of dermoscopic images relies on pattern recognition, and the development of expert-level proficiency typically requires extensive training and years of practice. While traditional methods of transferring knowledge have proven effective, technological advances may significantly improve upon these strategies and better equip dermoscopy learners with the pattern recognition skills required for real-world practice. Objectives: A narrative review of the literature was performed to explore emerging directions in medical image interpretation education that may enhance dermoscopy education. This article represents the first of a two-part review series on this topic. Methods: To promote innovation in dermoscopy education, the International Skin Imaging Collaborative (ISIC) assembled a 12-member Education Working Group that comprises international dermoscopy experts and educational scientists. Based on a preliminary literature review and their experiences as educators, the group developed and refined a list of innovative approaches through multiple rounds of discussion and feedback. For each approach, literature searches were performed for relevant articles. Results: Through a consensus-based approach, the group identified a number of emerging directions in image interpretation education. The following theory-based approaches will be discussed in this first part: whole-task learning, microlearning, perceptual learning, and adaptive learning. Conclusions: Compared to traditional methods, these theory-based approaches may enhance dermoscopy education by making learning more engaging and interactive and reducing the amount of time required to develop expert-level pattern recognition skills. Further exploration is needed to determine how these approaches can be seamlessly and successfully integrated to optimize dermoscopy education.
Impact of Electrical Impedance Spectroscopy on Clinician Confidence and Diagnostic Accuracy in Evaluating Melanocytic Skin Lesions Suspicious for Melanoma: A Pilot Study
Kolla, Avani; Fried, Lauren; Shah, Payal; Liebman, Tracey; Stein, Jennifer; Polsky, David
Introduction: Nevisense is a non-invasive device that measures electrical impedance spectroscopy (EIS) of individual skin lesions to aid in the diagnosis of melanoma. While EIS has demonstrated high sensitivity in diagnosing melanoma, its impact on a clinician"™s diagnostic confi dence remains unknown. Objective: To conduct a pilot study to evaluate whether clinician diagnostic confidence, sensitivity, specificity and accuracy can be increased by adding EIS measurement scores to clinical and dermoscopic images of lesions clinically suspicious for melanoma. Methods: Three pigmented lesions specialists and three 4th year medical students completed an online survey to evaluate 34 melanocytic lesions suspicious for melanoma. For each lesion, participants provided their diagnosis, biopsy recommendation, and confidence in diagnosing a lesion as benign or malignant based on history and clinical and dermoscopic images, and again after receiving an EIS score. Results: Addition of EIS scores increased mean biopsy sensitivity for melanoma/severely dysplastic nevi from 70% to 84% (p =.014) and mean diagnostic accuracy from 74% to 86% (p =.005). Mean diagnostic confidence increased for all histopathologic categories for both students and dermatologists (all p <.05). Conclusions: In this pilot study, EIS increased novice and expert diagnosticians"™ confidence regarding dermoscopically equivocal melanocytic lesions. Further studies are needed to explore how EIS can help clinicians reassure patients regarding the management of clinically dysplastic melanocytic nevi.
Melanoma surveillance for high-risk patients via telemedicine: Examination of real-world data from an integrated store-and-forward total body photography and dermoscopy service
Tan, Andrea; Greenwald, Elizabeth; Bajaj, Shirin; Belen, Debbie; Sheridan, Taylor; Stein, Jennifer A; Liebman, Tracey N; Bowling, Adrian; Polsky, David
Dermoscopy of acquired pigmentary disorders: a comprehensive review
Krueger, Loren; Saizan, Autumn; Stein, Jennifer A; Elbuluk, Nada
Dermoscopy has traditionally been used for the diagnosis of neoplasms and more recently in the evaluation of inflammatory conditions. Recent observational studies have suggested a role for dermoscopy in identifying and differentiating acquired pigmentary disorders. This comprehensive review will summarize the growing literature on the use of dermoscopy for pigmentary disorders. A literature review was performed on PubMed dating from inception to October 2020. The following pigmentary disorders were included in this study: melasma, solar lentigines, poikiloderma of Civatte, exogenous ochronosis, lichen planus pigmentosus, erythromelanosis follicularis faciei et colli, pigmented contact dermatitis, Riehl's melanosis, postinflammatory hyperpigmentation, erythema dyschromicum perstans, ashy dermatosis, confluent and reticulated papillomatosis, acanthosis nigricans, pityriasis versicolor, tinea versicolor, idiopathic guttate hypomelanosis, and vitiligo. Search terms used included each pigmentary disorder along with the terms "dermoscopy" or "dermatoscopy." Relevant case reports and case series were included. Many pigmentary disorders have unique and distinguishable features on dermoscopy. Given that these disorders can be clinically challenging for clinicians and emotionally distressing for patients, dermoscopy provides an additional, useful tool in the evaluation and assessment process.
Revisiting Solitary Pedunculated Lipofibromas
Adotama, Prince; Hutson, Seneca D; Rieder, Evan A; Stein, Jennifer A; Kim, Randie H
OBJECTIVES/OBJECTIVE:Pedunculated lipofibromas are soft, compressible, skin-colored nodules that typically present as an acquired solitary lesion, predominantly located on the buttocks and thighs. We aimed to differentiate between pedunculated lipofibromas and nevus lipomatosus superficialis. Although benign, this may be important as treatment options vary. METHODS:We describe 3 cases of solitary pedunculated lipofibromas occurring in older, obese adults that required clinicopathologic correlation for the correct diagnosis. RESULTS:The histopathologic features of pedunculated lipofibromas include a broad-based lesion with aggregates of mature adipocytes extending upwards into the dermis without an associated inflammatory infiltrate. The primary histopathologic differential diagnoses include fibroepithelial polyps with adipocytes and nevus lipomatosus superficialis, which is more frequently found in children or young adults and is typically characterized clinically by multiple lesions with a cerebriform to verrucoid surface. CONCLUSIONS:While the precise relationship between pedunculated lipofibromas and nevus lipomatosus is still unknown, we propose using pedunculated lipofibroma as a more specific clinical term to refer to solitary pedunculated or broad-based fatty lesions with a smooth surface that occur in older patients and in a wide anatomic distribution.
Real world outcomes of melanoma surveillance using the MoleMap NZ telemedicine platform
Greenwald, Elizabeth; Tan, Andrea; Stein, Jennifer A; Liebman, Tracey N; Bowling, Adrian; Polsky, David
BACKGROUND:MoleMap NZ is a novel New Zealand based store-and-forward telemedicine service to detect melanoma. It utilizes expert review of total body photography and close-up and dermoscopic images of skin lesions suspicious for malignancy. OBJECTIVE:The purpose of this study was to assess the effectiveness of MoleMap NZ as a melanoma early detection program. METHODS:We conducted a review of 2,108 melanocytic lesions recommended for biopsy/excision by MoleMap NZ dermoscopists from January 2015-December 2016. RESULTS:Pathologic diagnoses were available for 1,571 lesions. Of these, 1,303 (83%) lesions were benign and 260 (17%) lesions were diagnosed as melanoma, for a melanoma-specific benign-to-malignant ratio of 5.0 to 1. The number-needed-to-biopsy one melanoma was 6. Among melanomas with available tumor thickness data (n=137), 92% were <0.8mm (range: in situ - 3.1mm), with in-situ melanomas comprising 74%. LIMITATIONS/CONCLUSIONS:Only lesions recommended for excision were analyzed. Pathology results were available for 75% of these cases. Tumor thickness data was available for 53% of melanomas diagnosed. CONCLUSION/CONCLUSIONS:This real-world study of MoleMap NZ, a community-based teledermoscopy program, suggests that it has the potential to increase patients' access to specialist expertise via telemedicine. Additional studies are needed to more accurately define its efficacy.