Genetic Testing: How should dermatologists be helping?

 Protocol to evaluate a pilot program to upskill clinicians in providing genetic testing for familial melanoma.

CA Primiero, et al. PLoS One. 2022 Dec 7;17(12):e0275926. https://doi.org/10.1371/journal.pone.0275926

We’re all hearing that the clinical genetics workforce can no longer meet the demand for genetic testing, given the increasing number of conditions where genetic testing may be considered. As dermatologists, many of us are being asked to directly request specific genetic tests but we often feel nervous about our lack of expertise in the field and as yet there doesn’t exist a clear pathway for how we should deal with communicating results.

We therefore read this protocol for a pilot study with interest- this group in Australia created a protocol to upskill dermatologists to provide genetic testing for familial melanoma (this process is called “mainstreaming”). They will subsequently randomise high-risk individuals to receive testing either from an upskilled dermatologist or a genetic counsellor. Various questionnaires and outcome assessments have been devised to enable comparison of patient-reported outcomes, based on provider type. The training described is thorough: a 2-hour workshop, case-based learning and mock consultations developed by 2 genetic counsellors. Then they do 2 real-life observed consultations and reflective learning.

We look forward to hearing the results. We wonder how many dermatologists reading this have already started directly arranging genetic testing and what training they have received? This training was specifically for the familial melanoma gene panel but there is a wide range of conditions where involvement of dermatology could improve access to testing, reduce waiting times and maybe even cut costs. How do you feel about it? Comment below!