Dahlén Gyllencreutz J, Paoli J, Bjellerup M, Bucharbajeva Z, Gonzalez H, Nielsen K, Sandberg C, Synnerstad I, Terstappen K, Wennberg Larkö A-M
Department of Dermatology and Venereology, Skaraborg Hospital, Skövde, Sweden.
Department of Dermatology and Venereology, Sahlgrenska University Hospital, Institute of Clinical Sciences at the Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
J Eur Acad Dermatol Venereol. 2017 May;31(5):898-903. doi: 10.1111/jdv.14147. Epub 2017 Mar 6.
Malignant melanoma and non-melanoma skin cancers are among the fastest increasing malignancies in many countries. With the help of new tools, such as teledermoscopy referrals between primary health care and dermatology clinics, the management of these patients could be made more efficient.
To evaluate the diagnostic agreement and interobserver concordance achieved when assessing referrals sent through a mobile teledermoscopic referral system as compared to referrals sent via the current paper-based system without images.
The referral information from 80 teledermoscopy referrals and 77 paper referrals were evaluated by six Swedish dermatologists. They were asked to answer questions about the probable diagnosis, the priority, and a management decision.
Teledermoscopy generally resulted in higher diagnostic agreement, better triaging and more malignant tumours being booked directly to surgery. The largest difference between the referral methods was seen for invasive melanomas. Referrals for benign lesions were significantly more often correctly resent to primary health care with teledermoscopy. However, referrals for cases of melanoma in situ were also incorrectly resent five times. The interobserver concordance was moderate with both methods.
By adding clinical and dermoscopic images to referrals, the triage process for both benign and dangerous skin tumours can be improved. With teledermoscopy, patients with melanoma especially can receive treatment more swiftly.
在许多国家，恶性黑色素瘤和非黑色素瘤皮肤癌是增长最快的恶性肿瘤之一。借助诸如基层医疗保健机构与皮肤科诊所之间的远程皮肤镜转诊等新工具，这些患者的管理可以变得更加高效。
评估通过移动远程皮肤镜转诊系统发送的转诊病例与通过当前无图像的纸质系统发送的转诊病例在评估时的诊断一致性和观察者间的一致性。
六名瑞典皮肤科医生对80例远程皮肤镜转诊病例和77例纸质转诊病例的转诊信息进行了评估。他们被要求回答有关可能的诊断、优先级和管理决策的问题。
远程皮肤镜检查通常能带来更高的诊断一致性、更好的分诊效果，并且有更多恶性肿瘤直接被安排手术。两种转诊方式之间最大的差异体现在侵袭性黑色素瘤上。通过远程皮肤镜检查，良性病变的转诊病例更常被正确转回基层医疗保健机构。然而，原位黑色素瘤病例的转诊也有五次被错误转回。两种方法的观察者间一致性均为中等。
通过在转诊病例中添加临床和皮肤镜图像，可以改善良性和危险皮肤肿瘤的分诊流程。借助远程皮肤镜检查，尤其是黑色素瘤患者可以更快地接受治疗。
