Title: 2017 GPARTS Dr Jonathan Fee
Funder: Health and Social Care Research and Development Division (HSC R&D) of Public Health Agency, Northern Ireland

Abstract: Background - Skin cancer is the commonest cancer diagnosed across Ireland, and the incidence of melanoma continues to rise. In Northern Ireland the incidence of melanoma in 2015 its highest rate on record, double the rate seen in the 1990s, with an even greater increase in incidence reported among men. The mortality rate of melanoma in Northern Ireland has also risen over the same period, with more deaths in 2015 than any other year except one. Metastatic melanoma is particularly difficult to treat, and melanomas over 4mm in thickness have a 5-year survival rate of under 50% (Northern Ireland Cancer Registry, 2017a). Similar patterns have been seen in the Republic of Ireland and throughout the United Kingdom (National Cancer Registry of Ireland, 2017; ISD Scotland, 2017; Office for National Statistics, 2017; Welsh Cancer Intelligence and Surveillance Unit, 2017). Non-melanoma skin cancers, including basal cell carcinoma and squamous cell carcinomas, are by far the commonest cancers diagnosed throughout Ireland, and although their mortality rates are much lower than that of melanoma, their incidence also continues to rise (National Cancer Registry of Ireland, 2017; Northern Ireland Cancer Registry, 2017b). Because of a lack of effective therapy for metastatic melanoma, the best management strategy is its detection at an early stage, followed by surgical excision with adequate margins. The Surgeon Neville Davis highlighted the importance of achieving early diagnosis of melanoma through a combination of public health education and profession medical education. He warned that, “Melanoma writes its message on the skin with its own ink and it is there for all to see. Unfortunately some see but do not comprehend” (Davis, 1978); advice that is still relevant today. Dermoscopy is a non-invasive technique for the observation of skin lesions in vivo. The skin lesion is covered with a fluid such as water or gel, and a hand-held dermatoscope is used to inspect the lesion. A dermatoscope contains a magnification lens, usually providing ten-times magnification. The dermatoscope has an integral light source, and the fluid placed on the surface of the skin eliminates reflection of light, and allows pigmented and vascular structures in the epidermis, dermo-epidermal junction and superficial dermis to be more easily visualised (Argenziano and Soyer, 2001; Campos-do-carmo and Ramos-e-silva, 2008). Dermoscopy has been shown to aid lesion recognition in General Practitioners trained in its use, and to improve recognition of melanoma without increasing unnecessary referrals to secondary care. A systematic review identified four studies exploring dermoscopy use among primary care physicians. In all studies, participants received training in dermoscopy. Three of the studies showed statistically significant improvement in sensitivity for malignant skin lesions when dermoscopy was used compared with clinical examination (Herschorn, 2012). One paper reported significantly improved excision and referral rates of benign lesions (Argenziano et al., 2006). What this suggests is that GPs can be trained in dermoscopy to a level that can improve their ability to identify melanoma, and that this can be achieved without increasing referral rates or excision rates of benign lesions. Research from several countries has investigated the use of dermoscopy among General Practitioners (Chamberlain and Kelly, 2007; Chappuis et al., 2016; Morris et al., 2017). However little is known about how GPs in the UK or Ireland use dermoscopy, nor how those who use it have been trained in its use. Research aim. The aim of this study is to assess General Practitioners’ perceptions of dermoscopy; and to examine how General Practitioners use dermoscopy and have been trained in its use. Research objectives. To assess General Practitioners’ perceptions of dermoscopy, its advantages and barriers to its use. To assess, where GPs use dermoscopy, how they use it in clinical practice, and how it affects their clinical practice. To assess what training, if any, GPs have had in dermoscopy, and their perceptions of training. To examine whether further training opportunities could facilitate the use of dermoscopy in General Practice. METHODS AND METHODOLOGY. Study design. A qualitative study involving semi structured interviews. Context and setting of study. The setting for this study will be General Practice in Northern Ireland. Study subjects. General Practitioners practising in Northern Ireland. Method. Study design. Semi-structured interviews. Study sample. Purposive sample of equal numbers or three groups: Established dermoscopy users (using dermoscopy for over one year) New dermoscopy users (started using dermoscopy within the last year) Dermoscopy non-users.


Research activity codes: 7.3 MANAGEMENT AND DECISION MAKING
Health categories: CANCER AND NEOPLASMS