I'm a doctor too and would love to hear more about the rationale and process for creating this.
It's quite interesting to have a binary distinction: 'concerned vs not concerned', which I guess would be more relevant for referring clinicians, rather than getting an actual diagnosis. Whereas naming multiple choice 'BCC vs melanoma' would be more of a learning tool useful for medical students..
Echoing the other comments, but it would be interesting to match the cards to the actual incidence in the population or in primary care - although it may be a lot more boring with the amount of harmless naevi!
Thanks for your comment. The main motivation for me in developing the app was that lots of my patients wanted me to guide them to a resource that can help them improve their ability to recognise skin cancer and, in my view, a good way to learn is to be forced to make a decision an then receive feedback on that decision.
For the patient I think the decision actually is binary - either (i) I contact a doctor about this skin lesion now or (ii) I wait for a bit to see what happens or do nothing. In reality most skin cancers are very obvious even to a non-expert and the reason they are missed are that patients are not checking their skin or have no idea what to look for.
I think you are right about the incidence - would be better to be a more balanced distribution of benign versus malignant, but I don't think it would be good to just show 99% harmless moles and 1% cancers (which is probably the accurate representation of skin lesions in primary care) since it would take too long for patients to learn the appearance of skin cancer.
> most skin cancers are very obvious even to a non-expert and the reason they are missed are that patients are not checking their skin or have no idea what to look for
I am a skin cancer doctor in Queensland and all I do is find and remove skin cancers (find between 10 and 30 every day). In my experience the vast majority of cancers I find are not obvious to other doctors (not even seen by them), let alone obvious to the patient. Most of what I find are BCCs, which are usually very subtle when they are small. Even when I point them out to the patient they still can't see them.
Also, almost all melanomas I find were not noticed by the patient and they're usually a little surprised about the one I point to.
In my experience the only skin cancers routinely noticed by patients are SCCs and Merkel cell carcinomas.
With respect, if "most skin cancers are very obvious even to a non-expert" I suggest the experts are missing them and letting them get larger than necessary.
I realise things will be different in other parts of the world and my location allows a lot more practice than most doctors would get.
Update: I like the quiz. Nice work! In case anyone is wondering, I only got 27/30. Distinguishing between naevus and melanoma without a dermatoscope on it is sometimes impossible. Get your skin checked.
Thanks for your kind words with regards to the app and well done for getting such a high score!. I agree that BCC is often subtle. My practice is also largely focused on skin cancer. I would say that the majority of melanomas (and SCCs) that I diagnose would be obvious to a patient that underwent a short period of focused training and checked their skin regularly. A possible explanation for the difference in our experience is that the incidence of skin cancer (and also atypical but benign moles) a lot higher in Australia than in the UK.
There would be quite the difference in our patient demographics.
I have quite a few patients from the UK who have had several skin cancers. Invariably they went on holidays to Italy or Spain as a child and soaked up the sun.
It's quite interesting to have a binary distinction: 'concerned vs not concerned', which I guess would be more relevant for referring clinicians, rather than getting an actual diagnosis. Whereas naming multiple choice 'BCC vs melanoma' would be more of a learning tool useful for medical students..
Echoing the other comments, but it would be interesting to match the cards to the actual incidence in the population or in primary care - although it may be a lot more boring with the amount of harmless naevi!