Skin cancers

Why aren’t Australian dermatologists using reflectance confocal microscopy?

Lack of access and formalised training, rather than clinical issues, are behind the sluggish uptake of reflectance confocal microscopy among Australian dermatologists, researchers say.

Use of the non-invasive imaging technique has exploded in the US and Europe, amid evidence it reduces the need for unnecessary biopsies of suspected skin cancers and increases diagnostic accuracy compared with dermoscopy alone.

From 2017 to 2019, Medicare and Medicaid payments for reflectance confocal microscopy (RCM) rose 105%, while the number of clinicians using the tool rose 63%.

But despite Australia’s globally high skin cancer rates, local dermatologists have been slow to adopt RCM, say the authors of a research letter in Australasian Journal of Dermatology (link here).

The researchers, led by Dr Genevieve Ho of Melanoma Institute Australia, canvassed the issue at a recent roundtable, asking 15 stakeholders to grade potential barriers to its uptake.

Lack of experts and limited use of existing devices were identified as the top obstacles – each receiving an average rating of 4.67 out of 5, the maximum score.

“In our opinion, this is due to a combination of factors, including training barriers in an already limited pool of experts,” the authors commented.

Behind that came the costs of resources and time, and lack of training, with one participant saying “user confidence to decrease use of biopsy” was needed to increase RCM use, according to the authors.

Other potential barriers included the lack of Medicare reimbursement, geographic issues, the lack of standardisation of image acquisition and reporting and medicolegal issues.

And all participants agreed that patient acceptability was of less relevance, with one clinician commenting that patients were already very willing to use RCM.

With that in mind, research into service and training delivery models was needed, particularly to overcome the key issues identified of training, expertise and confidence of users, organisational support and costs.

“Structured education is required to ensure the high quality of RCM delivery and to justify a Medicare rebate and/or cost to the patient,” the authors wrote.

“These will further add to the sustainable implementation of the technology. Ongoing evaluation of the implementation of RCM in Australia is required.”

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