Training on Skin Cancer Diagnosis in Rheumatologists : Results from a Nationwide Randomized Web-Based Survey

Patients with inflammatory rheumatisms, such as rheumatoid arthritis, are more prone to develop skin cancers than the general population, with an additional increased incidence when receiving TNF blockers. There is therefore a need that physicians treating patients affected with inflammatory rheumatisms with TNF blockers recognize malignant skin lesions, requiring an urgent referral to the dermatologist and a potential withdrawal or modification of the immunomodulatory treatment. We aimed to demonstrate that an online training dedicated to skin tumors increase the abilities of rheumatologists to discriminate skin cancers from benign skin tumors. A nationwide randomized web-based survey involving 141 French rheumatologists was conducted. The baseline evaluation included short cases with skin lesion pictures and multiple choice questions assessing basic knowledge on skin cancers. For each case, rheumatologists had to indicate the nature of skin lesion (benign; premalignant/malignant), their level of confidence in this diagnosis (10-points Likert scale), and the precise dermatological diagnosis among 5 propositions. Different scores were established. After randomization, only one group had access to the online formation consisting in 4 elearning modules on skin tumors, of 15 minutes each (online training group). After reevaluation, the trained and the non-trained group (control group) were compared. The primary end-point was the number of adequate diagnoses of the nature of the skin lesions. The PLOSONE | DOI:10.1371/journal.pone. 0127564 May 21, 2015 1 / 9 OPEN ACCESS Citation: Viguier M, Rist S, Aubin F, Leccia M-T, Richard M-A, Esposito-Farèse M, et al. (2015) Online Training on Skin Cancer Diagnosis in Rheumatologists: Results from a Nationwide Randomized Web-Based Survey. PLoS ONE 10(5): e0127564. doi:10.1371/journal.pone. 0127564 Academic Editor: Anthony W.I. Lo, Queen Mary Hospital, HONG KONG Received: February 26, 2015 Accepted: April 16, 2015 Published: May 21, 2015 Copyright: © 2015 Viguier et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Data Availability Statement: All relevant data are within the paper. Funding: The study was supported by an unrestricted grant from Abbvie Ltd. The funder had no role in study design, analysis, decision to publish or preparation of the manuscript. Competing Interests: The authors received funding from a commercial source, Abbvie Ltd. This does not alter the authors' adherence to PLOS ONE policies on sharing data and materials. mean number of adequate diagnosis for the benign versus premalignant/malignant nature of the lesions was higher in the online training group (13.4 vs. 11.2 points; p value <0.0001). While the other knowledge scores were also significantly higher, no statistical difference was observed on the level of self-confidence between the 2 groups. In conclusion, the online formation was effective to improve the rheumatologists’ ability to diagnose skin cancer.