Jones Leah, Jameson Michael, Oakley Amanda
Waikato District Health Board, Hamilton 3204, New Zealand.
Waikato Clinical Campus, University of Auckland, Hamilton 3204, New Zealand.
Cancers (Basel). 2021 Nov 20;13(22):5828. doi: 10.3390/cancers13225828.
We undertook a retrospective comparison of two teledermatology pathways that provide diagnostic and management advice for suspected skin cancers, to evaluate the time from referral to diagnosis and its concordance with histology. Primary Care doctors could refer patients to either the Virtual Lesion Clinic (VLC), a nurse-led community teledermoscopy clinic or, more recently, to the Suspected Skin Cancer (SSC) pathway, which requires them to attach regional, close-up, and dermoscopic images. The primary objective of this study was to determine the comparative time course between the SSC pathway and VLC. Secondary objectives included comparative diagnostic concordance, skin lesion classification, and evaluation of missed skin lesions during subsequent follow-up. VLC referrals from July to December 2016 and 2020 were compared to SSC referrals from July to December 2020. 408 patients with 682 lesions in the VLC cohort were compared with 480 patients with 548 lesions from the 2020 SSC cohort, matched for age, sex, and ethnicity, including histology where available. Median time (SD) from referral to receipt of teledermatology advice was four (2.8) days and 50 (43.0) days for the SSC and VLC cohorts, respectively ( < 0.001). Diagnostic concordance between teledermatologist and histopathologist for benign versus malignant lesions was 70% for 114 lesions in the SSC cohort, comparable to the VLC cohort (71% of 122 lesions). Referrals from primary care, where skin lesions were imaged with variable devices and quality resulted in faster specialist advice with similar diagnostic performance compared to high-quality imaging at nurse-led specialist dermoscopy clinics.
我们对两条为疑似皮肤癌提供诊断和管理建议的远程皮肤病学途径进行了回顾性比较，以评估从转诊到诊断的时间及其与组织学的一致性。初级保健医生可以将患者转诊至虚拟病变诊所（VLC），这是一个由护士主导的社区皮肤镜检查诊所，或者，最近可以转诊至疑似皮肤癌（SSC）途径，该途径要求他们附上局部、特写和皮肤镜图像。本研究的主要目的是确定SSC途径和VLC之间的比较时间进程。次要目标包括比较诊断一致性、皮肤病变分类，以及评估后续随访期间漏诊的皮肤病变。将2016年7月至12月和2020年的VLC转诊病例与2020年7月至12月的SSC转诊病例进行比较。VLC队列中的408例患者有682处病变，与2020年SSC队列中的480例患者有548处病变进行比较，根据年龄、性别和种族进行匹配，包括在可获得组织学结果的情况下进行匹配。SSC和VLC队列从转诊到收到远程皮肤病学建议的中位时间（标准差）分别为4（2.8）天和50（43.0）天（<0.001）。SSC队列中114处病变的远程皮肤科医生与组织病理学家之间对良性与恶性病变的诊断一致性为70%，与VLC队列相当（122处病变中的71%）。与护士主导的专科皮肤镜检查诊所的高质量成像相比，初级保健机构的转诊病例中，使用不同设备和质量成像的皮肤病变能更快获得专科建议，且诊断性能相似。
