Embracing Dermoscopy in General Practice: Insights from a Qualitative Study

Skin examinations form a notable part of general practice consultations, with the potential for identifying skin cancers at an early stage. Despite the increasing referrals to dermatology departments, the adoption of dermoscopy—a valuable tool for skin lesion assessment—among general practitioners (GPs) in the UK remains limited. This qualitative study sought to explore the factors influencing the use of dermoscopy in primary care.

Methods

The study employed a qualitative interview approach within UK general practice settings. A diverse group of GPs was purposefully sampled,dermoscopy of actinic keratosis including both users and non-users of dermoscopy. Semi-structured interviews were conducted, transcribed, and analyzed using thematic analysis to identify key themes influencing dermoscopy use.

Results

The study revealed that the capability of GPs to use dermoscopy was significantly influenced by the receipt of adequate training, prior experience in dermatology, and supportive colleagues. While the use of dermoscopy was generally perceived to positively impact patient consultations, concerns about equipment costs and ethical considerations in sharing patient images for training purposes were highlighted.

Themes Influencing Dermoscopic Use

1. Capability: GPs felt confident in using dermoscopy when they had undergone proper training, had relevant experience, and received support from peers.

2. Clinical Impact: Dermoscopic use was seen to enhance the diagnostic process, patient confidence, and potentially reduce unnecessary referrals, although it did not add to the workload.

3. Acceptability: Attitudes towards dermoscopy varied from enthusiasm due to its benefits in primary care, to reluctance and skepticism due to perceived complexity and existing pressures on GPs.

Discussion

The study findings complement existing literature by providing a deeper understanding of the factors influencing dermoscopy use in primary care. The importance of adequate training was emphasized, with the need for competency standards to assess and improve training programs. The study also highlighted the potential ethical issues surrounding the use of online peer groups for professional support and the use of patient images for training.

This qualitative study underscores the importance of training, support, and ethical considerations in the adoption of dermoscopy in primary care. While GPs recognize the benefits of dermoscopy in improving skin assessments, addressing barriers such as equipment costs and enhancing dermatology confidence is crucial for wider adoption. The findings are relevant to primary care providers and those responsible for GP training and funding.