J Am Pharm Assoc (2003). 2021 Jan-Feb;61(1):81-86. doi: 10.1016/j.japh.2020.09.012. Epub 2020 Oct 14.
OBJECTIVE(S): To evaluate the frequency of nonmelanoma skin cancer (NMSC), NMSC precursors, and melanoma on a store-and-forward dermatology model featuring the pharmacist as the patient's point-of-contact. The secondary objective was to define lesion changes and symptoms perceived by patients (clinical prediction rules by nonexpert observers) that can be predictive of malignity.
A cross-sectional study of teledermatology consultation was performed. All patients who underwent a teledermatology consultation between September 2018 and March 2020 were included. A patient could have more than 1 lesion per consultation. The object of the study was a defined dermatologic lesion. The differences between the variables were analyzed using a univariate model based on the chi-square test for independent qualitative variables and Fisher exact test in cases when the expected values in any of the cells of a contingency table were less than 5. Statistical significance was set at P < 0.05 (2-tailed).
A total of 225 lesions in 218 patients were considered for this study; 53.8% (n = 121) of the lesions were classified as benign, 16.4% (n = 37) as dubious, 23.1% (n = 52) as NMSC precursors, 5.8% (n = 13) as NMSC, and 0.9% (n = 2) as melanomas. Of the reported clinical lesion changes, spontaneous pain, pruritus, surface texture changes, color changes, or form changes had no statistically significant relationship with the diagnostic group, whereas the presence of spontaneous bleeding (P = 0.015) and size changes (P = 0.026) were more frequently observed in the "dubious lesion" and "of oncological relevance lesion" groups.
This "direct-to-consumer," store-and-forward teledermatology with dermoscopy model featuring the pharmacist as the patient's point-of-contact is useful for the diagnosis of melanoma, NMSC, and NMSC precursors when backed by a robust dermatology service.
评估以药剂师为患者联络点的存储转发皮肤病学模型中皮肤癌（NMSC）、NMSC 前体和黑色素瘤的发生频率。次要目标是确定病变变化和患者感知的症状（非专家观察者的临床预测规则），这些变化和症状可以预测恶性肿瘤。
对远程皮肤病学咨询进行了横断面研究。所有在 2018 年 9 月至 2020 年 3 月期间进行远程皮肤病学咨询的患者均纳入研究。每位患者可在每次咨询中出现多个病变。本研究的对象是一个明确的皮肤科病变。使用基于卡方检验的单变量模型分析变量之间的差异，对于任何列联表中的预期值小于 5 的情况，使用 Fisher 精确检验。统计学意义设定为 P<0.05（双侧）。
共有 218 名患者的 225 个病变被纳入本研究；53.8%（n=121）的病变被归类为良性，16.4%（n=37）为可疑，23.1%（n=52）为 NMSC 前体，5.8%（n=13）为 NMSC，0.9%（n=2）为黑色素瘤。在所报告的临床病变变化中，自发性疼痛、瘙痒、表面质地变化、颜色变化或形态变化与诊断组之间没有统计学显著关系，而自发性出血（P=0.015）和大小变化（P=0.026）的存在更常见于“可疑病变”和“有肿瘤相关性病变”组。
这种“直接面向消费者”的、以药剂师为患者联络点的存储转发远程皮肤病学加皮肤镜检查模型，在有强大皮肤科服务支持的情况下，可用于诊断黑色素瘤、NMSC 和 NMSC 前体。
