Expert Consensus Statement on Proficiency Standards for Dermoscopy Education in Primary Care.

BACKGROUND: Primary care providers (PCPs) frequently address dermatologic concerns and perform skin examinations during clinical encounters. For PCPs who evaluate concerning skin lesions, dermoscopy (a noninvasive skin visualization technique) has been shown to increase the sensitivity for skin cancer diagnosis compared with unassisted clinical examinations. Because no formal consensus existed on the fundamental knowledge and skills that PCPs should have with respect to dermoscopy for skin cancer detection, the objective of this study was to develop an expert consensus statement on proficiency standards for PCPs learning or using dermoscopy. METHODS: A 2-phase modified Delphi method was used to develop 2 proficiency standards. In the study's first phase, a focus group of PCPs and dermatologists generated a list of dermoscopic diagnoses and associated features. In the second phase, a larger panel evaluated the proposed list and determined whether each diagnosis was reflective of a foundational or intermediate proficiency or neither. RESULTS: Of the 35 initial panelists, 5 PCPs were lost to follow-up or withdrew; 30 completed the fifth and last round. The final consensus-based list contained 39 dermoscopic diagnoses and associated features. CONCLUSIONS: This consensus statement will inform the development of PCP-targeted dermoscopy training initiatives designed to support early cancer detection.

Responses of Lipolexis oregmae (Hymenoptera: Aphidiidae) to different instars of Toxoptera citricida (Homoptera: Aphididae).

The effects of host instar of Toxoptera citricida Kirkaldy (Homoptera: Aphididae) on the performance of the parasitoid Lipolexis oregmae (Gahan) (Hymenoptera: Aphidiidae), originally Lipolexis scutellaris Mackauer, were evaluated in an effort to increase basic knowledge of this host-parasitoid association, improve field sampling methods, and potentially predict the success of parasitism in the field. L. oregmae was able to oviposit and develop in all four instars of T. citricida; however, there are differences in the quality of different host instars. Although second-instar hosts produce more L. oregmae progeny and a higher female-biased sex ratio, fourth-instar hosts produce L. oregmae progeny that are larger and have a higher realized fecundity. However, fourth-instar hosts require a longer handling time and expose the parasitoid female to more aphid behavioral defenses than do second-instar hosts. Additionally, results suggest that fourth-instar hosts may elicit a physiological immune response to parasitism; when aphids were observed being stung once, the number of L. oregmae larvae present on dissection after 4 d and the number of eclosed adults was lower in fourth- than in second-instar hosts. Pupal mortality of L. oregmae was also higher in fourth-instar hosts compared with second-instar hosts. The results of this study confirm that L. oregmae has a high reproductive rate and low incidence of incomplete parasitization on this host and is one of only a few natural enemies able to complete development in all instars of the brown citrus aphid in Florida.