Outcomes of Referral to Dermatology for Suspicious Lesions

Viola, Kate V.; Tolpinrud, Whitney L.; Gross, Cary P.; Kirsner, Robert S.; Imaeda, Suguru; Federman, Daniel G.

doi:10.1001/archdermatol.2011.108

Cited by 68 publications

(52 citation statements)

References 27 publications

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“…Melanomas found by an FTF dermatologist, but not initially identified by the referring PCP, have been termed ''incidental melanomas.'' 12 Kingsley-Loso et al posited that up to 37% of melanomas would have been missed without a FBSE.…”

Section: Discussionmentioning

confidence: 99%

“…[7][8][9][10][11] This concern is more related to the perceived inability of primary care providers (PCPs) to direct imaging of suspicious lesions than to the SFT dermatologist's ability to diagnose them. [12][13][14] At least three previous studies have ascertained the frequency of ''incidental'' melanomas in populations of patients referred for FTF dermatology care. An incidental melanoma is defined as a melanoma discovered by a dermatologist during full body skin examination (FBSE), but was not the subject of the referral.…”

Section: Introductionmentioning

confidence: 99%

“…Viola et al discovered 6 incidental melanomas in 400 referrals for suspected skin cancer to the VHA Connecticut Healthcare System. 12 Aldridge et al discovered 5 incidental melanomas among 336 patients referred from primary care for evaluation of lesions suspicious for skin cancer. 13 Kingsley-Loso et al discovered 87…”

Section: Introductionmentioning

confidence: 99%

“…14 Based on these studies, there is justifiable concern that unimaged melanomas may be present in patients being referred to SFT for other dermatologic concerns. 1,[12][13][14][15] We conducted this quality improvement study to ascertain the frequency at which unimaged melanomas occurred among patients enrolled in a VA SFT program and to determine what, if any, policy and procedural changes might be necessary to improve the program.…”

Section: Introductionmentioning

confidence: 99%

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Unimaged Melanomas in Store-and-Forward Teledermatology

Gendreau

Gemelas

Wang

et al. 2017

Telemedicine and e-Health

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Background: Store-and-forward teledermatology (SFT) readers can only diagnose what is imaged. This limitation has caused concern regarding the ability of primary care to direct imaging of lesions suspicious for melanoma. Melanomas not imaged by primary care providers (PCPs) are termed unimaged melanomas. Objective: To determine the frequency of unimaged melanomas among Veterans referred for care in a SFT program. Materials and Methods: All SFT patients with melanoma diagnosis were ascertained by query of the VA corporate data warehouse, Veterans Integrated Service Network 20 store-andforward program database, and the VA Computerized Patient Record System. Results: Between July 1, 2009 and December 31, 2011, 12,863 SFT consultations were conducted on 7,960 Veterans. Sixty-nine melanomas met inclusion and exclusion criteria; 13 melanomas were unimaged. The frequency of unimaged melanoma was 10.1 per 10,000 consultations. Discussion: Our calculated frequency of unimaged melanomas associates SFT with noninferiority to face-to-face care. This study was conducted on an exclusively Veteran population, precluding generalizability to the general population. Conclusions: PCPs referring to store-and-forward teledermatology may fail to image melanomas.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Unimaged Melanomas in Store-and-Forward Teledermatology

Gendreau

Gemelas

Wang

et al. 2017

Telemedicine and e-Health

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“…The evidence is persuasive that experts will remove fewer benign lesions with no loss of sensitivity for serious ones. 5,6 In this particular instance, gatekeepers are likely to increase not decrease healthcare costs.…”

mentioning

confidence: 99%

Industrializing skin cancer care: better and cheaper?

Rees

2012

J R Soc Med

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Skin cancer is the commonest cancer in European populations, with incidence rates in the UK for non-melanoma skin cancer (NMSC) and melanoma of 115 and 16 per 100,000 respectively (figures for NMSC are likely underestimates as registration is known to be incomplete). 1Despite the high frequency, overall UK skin cancer-related mortality is low with absolute rates of 0.5 for NMSC and 2.6 per 100,000 for melanoma. 2 The purpose of skin cancer treatment is to reduce case-fatality by removal of cancers before they have metastasized, and to minimize morbidity and disfigurement from the direct effects of the primary tumour.The current management of skin cancer in the UK and many countries is based on what might be termed a 'corner shop' model. Patients present to their GP or to a single-handed dermatologist in office practice and either (i) are diagnosed as not needing further treatment because the suspect lesion is benign, (ii) undergo excision of the suspect lesion by their physician or (iii) are referred to an expert (often hospital based) for further diagnosis and surgery if needed. All these consultations are likely very typical traditional 'medical' consultations, with a single doctor and patient operating in isolation with, to coin a phrase, the patient walking into the consultations room and then 'shaking hands with their physician'. I suggest that this traditional model is unnecessarily expensive and likely inferior in quality to a more industrialized model. To understand why change is necessary, we need to start with the changing epidemiology of skin cancer, and highlight changes in the skill mix of physicians.Standardized rates of skin cancer have risen 3-5-fold over the last 30 years in many European populations.1 Allowing for changes in age structure, such increases imply a seven-fold increase in the number of cases of the most common skin cancer, basal cell carcinoma. Today, referrals for diagnosis and management of skin cancer account for 50% of referrals to most dermatology units. Modelling suggests that skin cancer case numbers will double over the next 23 years.

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