Will Young Doctors Recognize Melanoma?

Fourth-year medical students – at least those at the University of Illinois at Chicago -- are not very proficient at detecting melanomas, the most serious type of skin cancer, researchers from that school said this week at the 69th annual meeting of the American Academy of Dermatology.

Actors wearing a medical moulage (a simulated melanoma) were examined for carpal tunnel syndrome with the moulage clearly in view, but less than a quarter of the 190 students saw the lesion and recommended treatment, according to Dr. Claudia Hernandez.

"Melanoma is really very rare, and it is not uncommon for medical students to go through four years of training and never see the real thing," she told Reuters Health. "We know that medical students do not feel all that confident doing skin examinations, and in this study, we wanted to see how proficient they were in detecting melanomas."

The students saw the actors while undergoing a test that uses simulated patient encounters to assess their clinical skills.

The medical moulage measured 3 to 4 mm in diameter and was applied to the second digit of the actor's hand. "A moulage is like a very realistic tattoo, but it's more than a tattoo because it's thicker and it's got texture to it. You could call them medical grade, very fancy tattoos," Hernandez said.

The actors, who pretended to have wrist pain, were trained beforehand by a dermatologist to answer questions regarding the history and symptoms of the simulated melanoma.

Fifty-six students noticed the lesion, but 13 failed to comment on it further to the patient or in their written notes.

Of the 43 students who saw the lesion and recommended follow-up or a biopsy, only one felt to see whether the patients had swollen lymph glands, and one student examined other areas of the pseudo-patient's skin for other unusual spots. No student offered the patient a full body skin examination.

The students who recommended follow-up also asked if the lesion had changed recently and also about symptoms. "These are the two most important questions, so this was the one encouraging finding," Hernandez noted.

These results are disturbing because the awareness about the dangers of skin cancer, especially the deadliness of melanoma, does not seem to be getting through to medical students. If they are not getting the message, then the public may not be getting the message either, she said.

Clearly, more educational efforts are needed to bring medical students up to speed in diagnosing melanoma and evaluating patients for skin cancer.

"Even though we give the medical students lectures about melanoma we have to make sure that they have some (way) to go ahead and practice these skills," she said. "Only then will they probably feel comfortable doing skin exams and diagnosing skin cancer."