Department of Dermatology and Allergy Centre, Odense University Hospital, Odense.
Audit Project Odense, Research Unit of General Practice, University of Southern Denmark, Odense.
Fam Pract. 2020 Sep 5;37(4):513-518. doi: 10.1093/fampra/cmaa041.
The increasing incidence of skin cancers poses a burden to health care systems. General practitioners (GPs) play an important role in triaging these diseases and referring relevant patients to specialists. It is challenging to distinguish benign from malignant skin lesions, and GPs may benefit from diagnostic support from teledermoscopy (TD).
To assess whether the introduction of TD in general practice was feasible and might reduce the number of unnecessary referrals to specialists and to assess the diagnostic accuracy and confidence of participating GPs.
Fifty general practices in Southern Denmark participated. Adult patients presenting to their GP with suspected skin cancer could be included. Images including dermoscopy were taken by the GP and sent for evaluation by specialized dermatologists at a university hospital. Patients were simultaneously referred for a face-to-face evaluation at the university hospital. Diagnoses proposed by the GPs and by TD were compared to the final diagnoses obtained by histopathology or, if not available, face-to-face evaluation.
Five hundred and nineteen patients with 600 suspected skin cancers were included. The final diagnosis was benign in 72.3%. The photo quality was good or fair in 90.5%. GPs reported uncertainty about their diagnoses in 41.5% of cases. The GPs' positive predictive values for any malignancy and for malignant melanoma were 49.5% and 26.3%, respectively. On evaluation by TD, 31.5% of lesions did not need further in-person assessment.
Useful images of suspicious skin lesions were obtained from general practice, and GPs could benefit from TD to improve their diagnostic accuracy and confidence.
皮肤癌发病率的上升给医疗保健系统带来了负担。全科医生（GP）在对这些疾病进行分诊并将相关患者转介给专科医生方面发挥着重要作用。区分良性和恶性皮肤病变具有挑战性，GP 可能受益于远程皮肤镜检查（TD）的诊断支持。
评估在一般实践中引入 TD 是否可行，是否可以减少不必要的专科转诊数量，并评估参与 GP 的诊断准确性和信心。
丹麦南部的 50 家全科诊所参与了该研究。患有疑似皮肤癌并向其 GP 就诊的成年患者均可纳入。GP 拍摄包括皮肤镜检查在内的图像，并将其发送给大学医院的皮肤科专家进行评估。同时，患者被转诊到大学医院进行面对面评估。GP 和 TD 提出的诊断与通过组织病理学获得的最终诊断或如果无法进行面对面评估，则与最终诊断进行比较。
共纳入了 519 名患有 600 例疑似皮肤癌的患者。最终诊断为良性的占 72.3%。照片质量好或一般的占 90.5%。GP 在 41.5%的病例中报告对其诊断不确定。GP 对任何恶性肿瘤和恶性黑色素瘤的阳性预测值分别为 49.5%和 26.3%。通过 TD 评估，31.5%的病变不需要进一步的面对面评估。
从一般实践中获得了可疑皮肤病变的有用图像，GP 可以从 TD 中受益，以提高他们的诊断准确性和信心。
