MRF 25th Anniversary: Improving Melanoma Screening Education for Primary Care Providers Serving Patients of Skin of Color

Melanoma in patients of skin of color (SOC) leads to worse health outcomes when compared to Caucasian patients. This is largely attributed to the perception of limited melanoma risk in patients of SOC by both physicians and patients. Current educational materials for melanoma screening are targeted primarily to light-skinned patients. Educational materials targeting patients of SOC are lacking, despite the atypical manner of melanoma presentation in patients of SOC. Screening for melanoma is primarily performed by primary care providers (PCPs) through full-body skin examinations. Thus, educating this physician group on melanoma screening is vital. Our project titled, “Improving Melanoma Screening Education for Primary Care Providers Serving Patients of Skin of Color” addresses the lack of PCP education on melanoma in patients of SOC.

Our goal was to adapt current high-quality online melanoma screening training to include relevant material to patients of SOC. This online training program, “War on Melanoma,” is part of the Oregon Health & Science University Dermatology Department’s efforts to increase melanoma screening practices. We added to this curriculum by creating educational modules on melanoma of the palms, soles and nails, also known as acral lentiginous melanoma. This type of melanoma disproportionately affects patients of SOC. Additionally, we created an educational video that teaches PCPs skin examination techniques that are important to utilize when evaluating patients of SOC for melanoma.

Thus far, we have recruited numerous PCPs in the Dallas-Fort Worth area to participate in our online training. PCPs first take a pre-training survey, in which they note their perceptions of risk for melanoma development in patients of SOC. This survey aims to determine whether PCPs believe patients of SOC are at risk to develop melanoma. Additionally, the PCPs take a pre-training quiz in which they evaluate numerous photographs of moles and determine whether the lesions appear suspicious for melanoma. Once complete, the PCPs then begin the melanoma screening training, approximately a 3-hour long endeavor.  After the training is completed, the PCPs then repeat the survey and quiz, called the post-training survey and quiz. Our research team records changes in the PCPs’ perceptions of melanoma risk in patients of SOC and their accuracy in identifying skin lesions suspicious for melanoma.

The final portion of our program involves an in-person screening event. This endeavor is ongoing as we soon plan to recruit patients of SOC to receive full-body skin examinations performed by both dermatologists and PCPs who have completed our training program. Here, we will have physicians look for skin spots they believe to be concerning for melanoma. We will compare responses from dermatologists to those of PCPs. As dermatologists have received formal training in identifying melanoma through their dermatology residency programs, we will use their responses as the “gold standard” to measure the efficacy of the online melanoma training program for our PCPs. This will allow for real-world implementation of skills acquired through online training by PCPs.

Our work addresses three key areas of need: 1) training providers how to conduct melanoma screening exams, 2) drafting educational materials relevant for patients of SOC, and 3) creating a metric to ascertain the efficacy of melanoma training programs. With respect to training and educational materials, prior research studies suggest that PCPs feel inadequately prepared to perform melanoma screening examinations. This finding has been reiterated in the preliminary results (unpublished data) of a cross-sectional study performed at The University of Texas Southwestern Medical Center (UTSW) where rural PCPs identified “lack of proper education” as a barrier to melanoma screening exams. Our project addresses this limitation by implementing an online training program accessible to PCPs virtually. Our project is novel as we are not aware of any  other online melanoma screening training programs targeted to patients of SOC. With respect to metrics, no standard measures of melanoma education efficacy exists. In a recent, unpublished pilot study at UTSW, nurses were trained to identify pigmented lesions appropriate for referral to a dermatologist using standard melanoma photos (a different training program than our online educational modules). These trained nurses were then asked to screen live patients for suspicious pigmented skin lesions appropriate for referral or biopsy. Their results were compared to board-certified dermatologists screening the same patients. The results revealed a lack of agreement between the nurses and dermatologists, further underscoring the need for rigorous evaluation of melanoma screening training efficacy. Our project implements real-world assessment of feasibility of an online training program through a live patient screening event, serving as a rigorous and realistic evaluation of training program success. We hope our work will help to address the lack of melanoma screening material specific to patients of SOC. We thank the Melanoma Research Foundation for their ongoing support of this project.

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