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[荷兰全科医生学院实践指南《可疑皮肤病变》]

[The Dutch College of General Practitioners practice guideline 'Suspicious skin lesions'].

作者信息

Damen-van Beek Z, Opstelten W

机构信息

*Namens de NHG-werkgroep Verdachte huidafwijkingen, waarvan de leden aan het eind van dit artikel vermeld staan.

出版信息

Ned Tijdschr Geneeskd. 2017;161:D1897.

Abstract
  • The Dutch College of General Practitioners practice guideline 'Suspicious skin lesions' provides recommendations for diagnosis, treatment and referral for the most common premalignant and malignant skin disorders.- The practice guideline includes a flowchart which starts by looking at the colour and surface of the skin lesion to direct the general practitioner to the most likely diagnosis.- In case of strong suspicion of squamous cell carcinoma, keratoacanthoma or melanoma and in case of basal cell carcinoma or Bowen's disease with high-risk characteristics, the general practitioner will refer the patient to a dermatologist.- The general practitioner will take into account the histopathological diagnosis in determining treatment and referral policy in case of other suspicious skin lesions. It will be obtained by means of punch biopsy or - in the case of naevi - diagnostic excision.- In case of suspicious skin lesions, the general practitioner will inspect the whole skin.- General practitioner and patient should determine a treatment plan together in case of actinic keratosis, histopathologically diagnosed basal cell carcinoma, and Bowen's disease. To this end, the practice guideline includes information on treatment options for general practitioners and dermatologists.
摘要
  • 荷兰全科医生学院的实践指南《可疑皮肤病变》针对最常见的癌前和恶性皮肤疾病的诊断、治疗及转诊提供了建议。

  • 该实践指南包含一个流程图,首先观察皮肤病变的颜色和表面情况,以指导全科医生做出最可能的诊断。

  • 若高度怀疑为鳞状细胞癌、角化棘皮瘤或黑色素瘤,以及存在具有高危特征的基底细胞癌或鲍恩病时,全科医生会将患者转诊至皮肤科医生处。

  • 对于其他可疑皮肤病变,全科医生在确定治疗和转诊策略时会考虑组织病理学诊断。这将通过打孔活检获取,对于痣则通过诊断性切除获取。

  • 对于可疑皮肤病变,全科医生会检查患者的整个皮肤。

  • 对于光化性角化病、组织病理学诊断为基底细胞癌和鲍恩病的情况,全科医生和患者应共同确定治疗方案。为此,该实践指南包含了针对全科医生和皮肤科医生的治疗选择信息。

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