Expert Consensus Provides Recommendations on Dermoscopy Standards for PAs

During the 2025 Society of Dermatology Physician Associates (SDPA) Fall Conference in San Antonio, Texas, a poster was presented titled 'Expert consensus recommendations on dermoscopy proficiency standards for physician assistants: results of a modified Delphi survey.'1

This article highlighted a new expert consensus report proposing the first formal set of dermoscopy proficiency expectations for physician assistants (PAs). The report was authored by such investigators as Peter A. Young, MPAS, PA-C. Young and colleauges' report touched on the long-standing gap in dermatology and primary care education observed in a period in which PAs' role is expanding role in the skin cancer space.

Dermoscopy is now widely regarded as crucial for clinicians who assess the presence pigmented lesions and is being increasingly included in training within the dermatology field. The process is also gaining traction in primary care as melanoma and non-melanoma skin cancer rates continue to see increases around the country.2

However, Young et al noted, despite the large number of PAs seeing patients across specialties, no agreed-upon dermoscopic learning objectives had been determined as guidelines for PA practices specifically. In this study, the investigative team sought to shift this paradigm.

Consensus Process Details

There were 14 experienced dermoscopists gathered for this consensus panel, including 8 dermatologists and 6 PAs with backgrounds in consensus-building efforts for clinician dermoscopy benchmarks, standardized testing frameworks, and recommended PA competencies. Young and coauthors noted most participants had significant experience with the dermoscopy technique: 86% had implemented dermoscopy for over 12 years and there was a mean of 15.5 years of use.

A modified Delphi process was utilized for the group, combining 2 rounds of electronic surveys with a facilitated roundtable discussion following these surveys.1 Those included as panelists assessed dermoscopic expectations across 54 diagnoses. The experts were asked to determine which of various conditions represent foundational knowledge for PAs who are in the early-career period in primary care versus in dermatology.

By the second survey round, the experts were successful in attaining a consensus on 39 of the 54 diagnoses, or 72%, determining such diagnoses as appropriate for inclusion in PA educational materials.1 The remaining 28% of these were determined by the panel to be lower-priority items and not essential for beginners. Ultimately, the expert panel endorsed 14 key conditions for PAs practicing in primary care and 25 for those who work in dermatology, which Young and colleagues noted indicates a higher degree of diagnostic complexity expected in specialty settings.

Impact on PA Training

The investigative team noted the strong interest in dermoscopy observed among those working as PAs. They highlighted prior national data indicating 77% of practicing PAs in all fields believe in the necessity of standard, formal dermoscopy instruction for their training. Dermatology-focused PA certification already involves dermoscopic content, but the team noted educators and supervising physicians lack guidance on which specific diagnoses constitute meaningful proficiency for those who are newer.

Overall, the expert consensus list generated through this study's process was designed to fill that void. As PAs continue to assume larger roles in dealing with patients showing suspicious lesions, the presence of shared dermoscopy training priorities may enhance diagnostic accuracy and even streamline collaboration among care teams.

Young and coauthors point to the potential of adopting these recommendations for professional organizations, training programs, and supervising dermatologists as leading to improved competence among PA trainees and early-career clinicians.

References

1. Young P, Middleton H, Seiverling E, et al. Expert consensus recommendations on dermoscopy proficiency standards for physician assistants: results of a modified Delphi survey. Presented at the Society of Dermatology Physician Associates (SDPA) Fall Conference, November 5-9, San Antonio, TX.

2. Lapides R, Saravi B, Roider E, et al. Possible Explanations for Rising Melanoma Rates Despite Increased Sunscreen Use over the Past Several Decades. Cancers (Basel). 2023 Dec 16;15(24):5868. doi: 10.3390/cancers15245868. PMID: 38136411; PMCID: PMC10741796.