title: Online training on skin cancer diagnosis in rheumatologists: results from a nationwide randomized web-based survey.
abstract: 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 e-learning 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 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.
authors.affiliation: Université Paris Diderot, Sorbonne Paris Cité, Paris, France; Assistance-Publique Hôpitaux de Paris (APHP), Hôpital Saint-Louis, Service de Dermatologie, Paris, France.
authors.forename: Manuelle
authors.initials: M
authors.lastname: Viguier
authors.affiliation: Service de Rhumatologie, Centre Hospitalier Régional (CHR), Orléans, France.
authors.forename: Stéphanie
authors.initials: S
authors.lastname: Rist
authors.affiliation: Université de Franche Comté, EA3181, SFR4234, Service de Dermatologie, Centre Hospitalier Universitaire (CHU), Besançon, France.
authors.forename: François
authors.initials: F
authors.lastname: Aubin
authors.affiliation: Clinique de Dermatologie, Allergologie et Photobiologie, CHU, Grenoble, France.
authors.forename: Marie-Thérèse
authors.initials: MT
authors.lastname: Leccia
authors.affiliation: Service de Dermatologie, Université Aix-Marseille, Centre de recherche en oncologie biologique et oncopharmacologie, Hôpital de la Timone, Assistance Publique Hôpitaux de Marseille, Marseille, France.
authors.forename: Marie-Aleth
authors.initials: MA
authors.lastname: Richard
authors.affiliation: Université Paris Diderot, Sorbonne Paris Cité, UMR 1123, Paris, France; APHP, Hôpital Bichat, Département d'Epidémiologie et Recherche Clinique, Centre de Pharmaco-épidémiologie (Céphépi), Paris, France; INSERM, CIC-EC 1425, UMR 1123, Paris, France.
authors.forename: Marina
authors.initials: M
authors.lastname: Esposito-Farèse
authors.affiliation: Clinique Universitaire de Rhumatologie, CHU Hôpital Sud, Grenoble, France.
authors.forename: Philippe
authors.initials: P
authors.lastname: Gaudin
authors.affiliation: Service de Rhumatologie, CHU, APHM, Marseille, France.
authors.forename: Thao
authors.initials: T
authors.lastname: Pham
authors.affiliation: Université Paris Diderot, APHP, Hôpital Lariboisière, Service de Rhumatologie, Paris, France.
authors.forename: Pascal
authors.initials: P
authors.lastname: Richette
authors.affiliation: Université de Franche Comté, Service de Rhumatologie, CHU, Besançon, France.
authors.forename: Daniel
authors.initials: D
authors.lastname: Wendling
authors.affiliation: INSERM UMR_S1109, Centre de Recherche d'Immunologie et d'Hématologie, Fédération de médecine translationelle, Université de Strasbourg, Strasbourg, France.
authors.forename: Jean
authors.initials: J
authors.lastname: Sibilia
authors.affiliation: Université Paris Diderot, Sorbonne Paris Cité, UMR 1123, Paris, France; APHP, Hôpital Bichat, Département d'Epidémiologie et Recherche Clinique, Centre de Pharmaco-épidémiologie (Céphépi), Paris, France; INSERM, CIC-EC 1425, UMR 1123, Paris, France.
authors.forename: Florence
authors.initials: F
authors.lastname: Tubach
mesh_terms: D000328:Adult; D004502:Education, Medical, Continuing; D005260:Female; D006801:Humans; D020407:Internet; D008297:Male; D008875:Middle Aged; D010820:Physicians; D012219:Rheumatology; D012878:Skin Neoplasms / Q000175:diagnosis*; D011795:Surveys and Questionnaires