Viola Kate V, Tolpinrud Whitney L, Gross Cary P, Kirsner Robert S, Imaeda Suguru, Federman Daniel G
Robert Wood Johnson Clinical Scholars Program, Yale University School of Medicine, New Haven, Connecticut, USA.
Arch Dermatol. 2011 May;147(5):556-60. doi: 10.1001/archdermatol.2011.108.
To determine the proportion of suspicious lesions referred by nondermatologists that are found to be malignant and the number of incidental skin cancers identified at the time of dermatology referral.
Retrospective cohort study.
Veterans Affairs Connecticut Healthcare System.
Four hundred patients referred by nondermatologists for skin lesions suspected of being malignant between January 1, 2006, through December 31, 2009.
Data collected included the type of referring provider, the final diagnosis by the dermatologist, and the number and type of incidental lesions.
Only 22.0% of the index lesions (ie, the lesions that prompted the referral) were found to be cancerous. In aggregate, 149 cancerous lesions were noted in 98 patients. However, only 88 (59.1%) were identified in the index lesion; 111 incidental lesions were biopsied by the consulting dermatologist, with 61 (55.0%) additional skin cancers identified. Twelve of the 61 incidental cancers (19.7%) were found in patients whose index lesion was clinically benign and was not biopsied.
Nondermatologists may benefit from focused educational initiatives on skin cancer detection, particularly the significance of the total body skin examination and the expectations for and limitations of teledermatology. A substantial proportion of malignant lesions was incidentally identified by the consulting dermatologist in addition to the primary lesion of concern. The use of teledermatology to assess a specific lesion of concern may be associated with underdiagnosis of clinically significant lesions that are not appreciated by the referring physician. Therefore, teledermatology must not be used as a substitute for a total body skin examination.
确定非皮肤科医生转诊的可疑病变中被发现为恶性的比例，以及皮肤科转诊时发现的偶然皮肤癌数量。
回顾性队列研究。
康涅狄格州退伍军人事务医疗系统。
2006年1月1日至2009年12月31日期间由非皮肤科医生转诊的400例疑似恶性皮肤病变患者。
收集的数据包括转诊医生类型、皮肤科医生的最终诊断以及偶然病变的数量和类型。
仅22.0%的索引病变（即促使转诊的病变）被发现为癌症。总共在98例患者中发现了149个癌性病变。然而，仅88个（59.1%）在索引病变中被识别；会诊皮肤科医生对111个偶然病变进行了活检，另外发现了61个（55.0%）皮肤癌。61个偶然癌症中有12个（19.7%）在索引病变临床良性且未活检的患者中发现。
非皮肤科医生可能会从关于皮肤癌检测的重点教育举措中受益，特别是全身皮肤检查的重要性以及远程皮肤病学的期望和局限性。除了主要关注的病变外，会诊皮肤科医生偶然发现了相当比例的恶性病变。使用远程皮肤病学评估特定的可疑病变可能与转诊医生未察觉的具有临床意义的病变诊断不足有关。因此，远程皮肤病学绝不能用作全身皮肤检查的替代方法。
