Ferrándiz Lara, Ruiz-de-Casas Andres, Martin-Gutierrez Francisco J, Peral-Rubio Francisco, Mendez-Abad Cristina, Rios-Martin Juan J, Moreno-Ramirez David
Dermatology Unit, Hospital Universitario Virgen Macarena, Seville, Spain.
Arch Dermatol. 2012 Sep;148(9):1025-8. doi: 10.1001/archdermatol.2012.778.
To evaluate differences in the initial prognosis of patients with cutaneous melanoma managed by teledermatology (TD) vs other non-TD referral systems.
Descriptive and longitudinal study of a store-and-forward TD system aimed at the triage of patients with suspicious pigmented lesions.
In 2003, a store-and-forward TD triage system aimed at the selection of patients with skin growths suggestive of cancer was implemented at a skin cancer clinic. This system has been shown to be accurate and reliable and able to significantly shorten waiting periods for consultation with a dermatologist.
Patients with primary cutaneous melanoma referred to the Melanoma Clinic of the Dermatology Unit, Hospital Universitario Virgen Macarena, Seville, Spain, by TD or non-TD tracks were included in the study.
Decisions on the referral of patients with suspicious skin lesions by store-and-forward TD vs by a conventional referral system. Breslow thickness and tumor stage were recorded in each study group (TD and non-TD) and were compared.
Two hundred one patients with primary cutaneous melanoma were enrolled in the study. In total, 33.3% were managed at their primary care center by teleconsultation, whereas 66.7% were managed by a conventional referral system. The mean Breslow thickness was significantly lower among patients in the TD group than among patients in the non-TD group (1.06 vs 1.64 mm, P = .03). The frequency of melanoma with a favorable initial prognosis (tumor stages Tis and T1a) was significantly higher in the TD group (70.1% vs 56.9%, P = .03). The odds ratio of having a cutaneous melanoma with a favorable initial prognosis in the TD group was 1.96 (95% CI, 1.14-3.50; P = .04).
Teledermatology as a screening system for cutaneous melanoma has a favorable effect on the initial prognosis of patients with melanoma.
评估通过远程皮肤病学（TD）管理的皮肤黑色素瘤患者与通过其他非TD转诊系统管理的患者在初始预后方面的差异。
对一个旨在对可疑色素沉着病变患者进行分诊的存储转发TD系统进行描述性和纵向研究。
2003年，一家皮肤癌诊所实施了一个旨在筛选疑似癌症皮肤病变患者的存储转发TD分诊系统。该系统已被证明准确可靠，能够显著缩短与皮肤科医生会诊的等待时间。
通过TD或非TD途径转诊至西班牙塞维利亚大学圣卡雷纳医院皮肤科黑色素瘤诊所的原发性皮肤黑色素瘤患者纳入本研究。
存储转发TD与传统转诊系统对可疑皮肤病变患者的转诊决策。记录每个研究组（TD和非TD）中患者的 Breslow厚度和肿瘤分期，并进行比较。
201例原发性皮肤黑色素瘤患者纳入本研究。总体而言，33.3%的患者在初级保健中心通过远程会诊进行管理，而66.7%的患者通过传统转诊系统进行管理。TD组患者的平均 Breslow厚度显著低于非TD组患者（1.06 vs 1.64 mm，P = .03）。TD组中初始预后良好（肿瘤分期Tis和T1a）的黑色素瘤频率显著更高（70.1% vs 56.9%，P = .03）。TD组中初始预后良好且患有皮肤黑色素瘤的优势比为1.96（95% CI，1.14 - 3.50；P = .04）。
远程皮肤病学作为皮肤黑色素瘤的筛查系统，对黑色素瘤患者的初始预后有积极影响。
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