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Sensitivity and Specificity for Skin Cancer Diagnosis in Primary Care Providers: a Systematic Literature Review and Meta-analysis of Educational Interventions and Diagnostic Algorithms

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A Correction to this article was published on 27 August 2022

This article has been updated

Abstract

Background

In areas without convenient access to dermatology care, primary care providers (PCPs) serve as an important patient resource for early skin cancer detection. To determine the most effective strategy for skin cancer detection training in PCPs, we conducted a systematic review of educational interventions and performed a meta-analysis on sensitivity and specificity outcomes in PCPs.

Objectives

To summarize data on skin cancer sensitivity and specificity outcomes for PCP-targeted training programs and diagnostic algorithms. Our PCP cohort included practicing physicians, trainee physicians, and advanced practice practitioners.

Methods

A literature search was performed in MEDLINE, Embase, Web of Science, and the Cochrane Library for relevant English-language articles published worldwide from 2000 onward. Results were screened for eligibility, and overlapping datasets were reconciled. Data extracted included the educational intervention, diagnostic algorithm, and outcomes of interest (sensitivity and specificity). Outcomes were pooled across interventions that taught the same diagnostic algorithm. A bivariate model was fit to compare different interventions/algorithms. This review followed the PRISMA guidelines.

Results

In total, 21 articles were included in this review, encompassing over 58,610 assessments of skin lesions by about 1529 participants worldwide. Training programs that implemented the triage-amalgamated dermoscopic algorithm (TADA) demonstrated high pooled sensitivity (91.7%) and high pooled specificity (81.4%) among PCPs.

Conclusions and Relevance

Overall, this systematic review and meta-analysis showed that dermoscopy training in PCPs was generally associated with gains in skin cancer sensitivity without loss of specificity. Clinically, this correlates with fewer skin cancers overlooked by PCPs and fewer excisions of benign lesions.

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Data Availability

All data compiled and analyzed in this review has been made available to the reader.

Change history

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Funding

This work is supported in part by the generous philanthropic contributions of the Lyda Hill Foundation to The University of Texas MD Anderson Cancer Center Moon Shots Program™. This work is also supported in part by a National Cancer Institute (NCI) Cancer Center Support Grant (Award No. P30 CA016672). The funding sources were not involved in the design or conduct of the study; the collection, management, analysis, or interpretation of the data; the preparation, review, or approval of the manuscript; or the decision to submit the manuscript for publication.

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Authors and Affiliations

  1. John P. and Kathrine G. McGovern Medical School, Houston, TX, USA

    Nadeen Gonna

  2. Department of Dermatology, The University of Texas MD Anderson Cancer Center, 1400 Pressler St, Unit 1452, Houston, TX, 77030, USA

    Tiffaney Tran & Kelly C. Nelson

  3. Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA

    Roland L. Bassett

  4. Research Medical Library, The University of Texas MD Anderson Cancer Center, Houston, TX, USA

    David P. Farris

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  1. Nadeen Gonna
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  5. Kelly C. Nelson
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Contributions

KCN, NG, and TT contributed to the study conceptualization and design. Literature search was performed by KCN, DPF, NG, and TT. Study selection and data collection were performed by TT, NG, and KCN. Data analysis was performed by RLB, TT, and KCN. The first draft of the manuscript was written by TT and NG, and all authors commented on previous versions of the manuscript. All authors reviewed and approved the final manuscript.

Corresponding author

Correspondence to Kelly C. Nelson.

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This is a secondary review of literature which has been published. Ethics approval was not required.

Consent to Participate

This review of published literature did not directly involve any human subjects. In this study, informed consent was not required.

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The authors declare no competing interests.

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Ms. Nadeen Gonna and Ms. Tiffaney Tran shared co-first authorship.

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Gonna, N., Tran, T., Bassett, R.L. et al. Sensitivity and Specificity for Skin Cancer Diagnosis in Primary Care Providers: a Systematic Literature Review and Meta-analysis of Educational Interventions and Diagnostic Algorithms. J Canc Educ 37, 1563–1572 (2022). https://doi.org/10.1007/s13187-022-02194-4

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