电子转诊和远程皮肤镜检查分级用于黑色素瘤：一种成功的护理模式。

E-referrals and teledermatoscopy grading for melanoma: a successful model of care.

机构信息

Department of Cutaneous Oncology, North Shore Hospital, Waitemata District Health Board, Takapuna, New Zealand.

Waikato Clinical Campus, University of Auckland, Hamilton, New Zealand.

出版信息

Australas J Dermatol. 2020 May;61(2):147-151. doi: 10.1111/ajd.13230. Epub 2020 Feb 16.

DOI:10.1111/ajd.13230

PMID:32064590

Abstract

BACKGROUND/OBJECTIVES: An e-referral system was developed at a tertiary care hospital in Auckland, New Zealand in 2014 for suspected cutaneous malignancy. E-referrals include patient information, a description of the lesion(s), biopsy results and/or attached photograph(s). Experienced surgical oncologists prioritised the referrals and selected a management option or referred them for a teledermatoscopy opinion. Our aim was to review the efficacy of e-referrals for improving diagnostic accuracy for melanoma.

METHODS

Referrals received in 2016 including images and categorisation as confirmed, likely or suspected melanoma by the triage specialist were evaluated. Concordance of the pathological diagnosis with the triage diagnosis and teledermatoscopy diagnosis was determined for each referral.

RESULTS

809 of 3470 e-referrals for skin cancer were categorised as confirmed, likely or suspected melanoma. 230 (28.4%) of these included a referral histopathology confirming melanoma/melanoma in situ. Of the remaining 579 referrals, 315 were sent for urgent diagnostic excision and 264 were referred for teledermatoscopy. 120 of the 315 sent for urgent excision were confirmed as melanoma (53) or melanoma in situ (67) on histopathology: a positive predictive value (PPV) of 38.1% and number needed to excise (NNE) of 2.6. Less than 10% of referrals triaged for teledermatoscopy were confirmed as melanoma (24/264). Almost half of all referrals (374/809, 45.6%) included melanoma/melanoma in situ. The melanoma: melanoma in situ ratio was 1: 1.18.

CONCLUSIONS

The e-referral and teledermatoscopy service for suspected melanoma has proven fewer unnecessary excisions of benign lesions than previously reported.

摘要

背景/目的：2014 年，新西兰奥克兰的一家三级保健医院开发了电子转诊系统，用于疑似皮肤恶性肿瘤。电子转诊包括患者信息、病变描述、活检结果和/或附加照片。经验丰富的外科肿瘤学家对转诊进行优先排序，并选择管理方案，或转介进行远程皮肤镜检查。我们的目的是回顾电子转诊对提高黑色素瘤诊断准确性的效果。

方法

评估了 2016 年收到的转诊，包括图像和分诊专家分类为确诊、可能或疑似黑色素瘤的病例。为每个转诊确定病理诊断与分诊诊断和远程皮肤镜诊断的一致性。

结果

3470 例皮肤癌电子转诊中有 809 例被归类为确诊、可能或疑似黑色素瘤。其中 230 例（28.4%）包括转诊组织病理学证实为黑色素瘤/原位黑色素瘤。在其余 579 例转诊中，315 例被送往紧急诊断性切除，264 例被转介进行远程皮肤镜检查。在 315 例被送往紧急切除的患者中，120 例组织病理学证实为黑色素瘤（53 例）或原位黑色素瘤（67 例）：阳性预测值（PPV）为 38.1%，切除所需数量（NNE）为 2.6。被分诊为远程皮肤镜检查的转诊中，不到 10%（24/264）被确诊为黑色素瘤。几乎一半的转诊（374/809，45.6%）包括黑色素瘤/原位黑色素瘤。黑色素瘤：原位黑色素瘤的比例为 1:1.18。