Lead Time From First Suspicion Of Malignant Melanoma In Primary Care To Diagnostic Excision: A Cohort Study Comparing Teledermatoscopy And Traditional Referral To A Dermatology Clinic At A Tertiary Hospital
Keywords:
teledermatoscopy, dermatoscopy, lead time, malignant melanoma, general practitionerAbstract
Introduction The increasing use of teledermatoscopy in clinical practice has led to demands to evaluate the effects of this new technology on traditional healthcare systems.
Objectives To study lead times from first consultation in primary care to diagnostic excision of suspected malignant melanoma lesions in traditional referrals to a tertiary hospital-based dermatology clinic compared with mobile teledermatoscopy referrals.
Methods A retrospective cohort study design was used. Data on sex, age, pathology report, names of caregivers, clinical diagnosis, date for first visit to primary care unit, and date for diagnostic excision were collected from medical records. Patients managed through traditional referral (n=53) were compared with patients managed at primary care units using teledermatoscopy (n=128) regarding lead time from first visit to diagnostic excision.
Results Mean time from date of first visit at primary care unit to diagnostic excision did not differ between the traditional referral and teledermatoscopy groups (16.2 vs. 15.7 days, median 10 vs. 13 days, p=0.657). Lead times from date of referral to diagnostic excision did not significantly differ (15.7 vs. 12.8 days, median 10 vs. 9 days, p=0.464).
Conclusions Our study indicates that lead time to diagnostic excision for patients with suspected malignant melanoma managed by teledermatoscopy was comparable and not inferior to that of the traditional referral pathway. If teledermatoscopy is used at first consultation in primary care, it could potentially be more efficient than traditional referral.
References
Eriksson H, Nielsen K, Vassilaki I, et al. Trend Shifts in Age-Specific Incidence for In Situ and Invasive Cutaneous Melanoma in Sweden. Cancers (Basel). 2021;13(11). DOI: 10.3390/cancers13112838. PMID:34200396.
Lyth J, Mikiver R, Nielsen K, Isaksson K, Ingvar C. Prognostic instrument for survival outcome in melanoma patients: based on data from the population-based Swedish Melanoma Register. Eur J Cancer. 2016;59:171-178. DOI: 10.1016/j.ejca.2016.02.029. PMID:27046697.
Tensen E, van der Heijden JP, Jaspers MW, Witkamp L. Two Decades of Teledermatology: Current Status and Integration in National Healthcare Systems. Curr Dermatol Rep. 2016;5:96-104. DOI: 10.1007/s13671-016-0136-7. PMID:27182461.
Lee KJ, Finnane A, Soyer HP. Recent trends in teledermatology and teledermoscopy. Dermatol Pract Concept. 2018;8(3):214-223. DOI: 10.5826/dpc.0803a13. PMID:30116667.
Fernemark H, Skagerström J, Seing I, Ericsson C, Nilsen P. Digital consultations in Swedish primary health care: a qualitative study of physicians' job control, demand and support. BMC Fam Pract. 2020;21(1):241. DOI: 10.1186/s12875-020-01321-8. PMID:33234111.
Kittler H, Pehamberger H, Wolff K, Binder M. Diagnostic accuracy of dermoscopy. Lancet Oncol. 2002;3(3):159-65. DOI: 10.1016/s1470-2045(02)00679-4. PMID:11902502.
Vestergaard ME, Macaskill P, Holt PE, Menzies SW. Dermoscopy compared with naked eye examination for the diagnosis of primary melanoma: a meta-analysis of studies performed in a clinical setting. Br J Dermatol. 2008;159(3):669-76. DOI: 10.1111/j.1365-2133.2008.08713.x. PMID:18616769.
Rosendahl C, Tschandl P, Cameron A, Kittler H. Diagnostic accuracy of dermatoscopy for melanocytic and nonmelanocytic pigmented lesions. J Am Acad Dermatol. 2011;64(6):1068-73. DOI: 10.1016/j.jaad.2010.03.039. PMID:21440329.
Kittler H, Seltenheim M, Pehamberger H, Wolff K, Binder M. Diagnostic informativeness of compressed digital epiluminescence microscopy images of pigmented skin lesions compared with photographs. Melanoma Res. 1998;8(3):255-60. DOI: 10.1097/00008390-199806000-00008. PMID:9664147.
Piccolo D, Peris K, Chimenti S, Argenziano G, Soyer HP. Jumping into the future using teledermoscopy. Skinmed. 2002;1(1):20-4. DOI: 10.1111/j.1540-9740.2002.01830.x. PMID:14673232.
Vestergaard T, Prasad SC, Schuster A, Laurinaviciene R, Andersen MK, Bygum A. Diagnostic accuracy and interobserver concordance: teledermoscopy of 600 suspicious skin lesions in Southern Denmark. J Eur Acad Dermatol Venereol. 2020;34(7):1601-1608. DOI: 10.1111/jdv.16275. PMID:32031277.
Börve A, Terstappen K, Sandberg C, Paoli J. Mobile teledermoscopy-there's an app for that! Dermatol Pract Concept. 2013;3(2):41-8. DOI: 10.5826/dpc.0302a05. PMID:23785643.
Arzberger E, Curiel-Lewandrowski C, Blum A, et al. Teledermoscopy in High-risk Melanoma Patients: A Comparative Study of Face-to-face and Teledermatology Visits. Acta Derm Venereol. 2016;96(6):779-83. DOI: 10.2340/00015555-2344. PMID:26776245.
Finnane A, Dallest K, Janda M, Soyer HP. Teledermatology for the Diagnosis and Management of Skin Cancer: A Systematic Review. JAMA Dermatol. 2017;153(3):319-327. DOI: 10.1001/jamadermatol.2016.4361. PMID:27926766.
Börve A, Dahlén Gyllencreutz J, Terstappen K, et al. Smartphone teledermoscopy referrals: a novel process for improved triage of skin cancer patients. Acta Derm Venereol. 2015;95(2):186-90. DOI: 10.2340/00015555-1906. PMID:24923283.
Congalton AT, Oakley AM, Rademaker M, Bramley D, Martin RC. Successful melanoma triage by a virtual lesion clinic (teledermatoscopy). J Eur Acad Dermatol Venereol. 2015;29(12):2423-8. DOI: 10.1111/jdv.13309. PMID:26370585.
Damsin T, Canivet G, Jacquemin P, et al. Value of Teledermoscopy in Primary Healthcare Centers: Preliminary Results of the TELESPOT Project in Belgium. Dermatol Ther (Heidelb). 2020;10(6):1405-1413. DOI: 10.1007/s13555-020-00445-0. PMID:32946049.
Moreno-Ramírez D, Argenziano G. Teledermatology and Mobile Applications in the Management of Patients with Skin Lesions. Acta Derm Venereol. 2017;Suppl 218:31-35. DOI: 10.2340/00015555-2718. PMID:28676881.
Witkowski AM, Łudzik J, Arginelli F, et al. Improving diagnostic sensitivity of combined dermoscopy and reflectance confocal microscopy imaging through double reader concordance evaluation in telemedicine settings: A retrospective study of 1000 equivocal cases. PLoS One. 2017;12(11):e0187748. DOI: 10.1371/journal.pone.0187748. PMID:29121636.
Łudzik J, Witkowski AM, Roterman-Konieczna I, Bassoli S, Farnetani F, Pellacani G. Improving Diagnostic Accuracy of Dermoscopically Equivocal Pink Cutaneous Lesions with Reflectance Confocal Microscopy in Telemedicine Settings: Double Reader Concordance Evaluation of 316 Cases. PLoS One. 2016;11(9):e0162495. DOI: 10.1371/journal.pone.0162495. PMID:27606812.
Pow RE, Mello-Thoms C, Brennan P. Evaluation of the effect of double reporting on test accuracy in screening and diagnostic imaging studies: A review of the evidence. J Med Imaging Radiat Oncol. 2016;60(3):306-14. DOI: 10.1111/1754-9485.12450. PMID:26996634.
Lim D, Oakley AM, Rademaker M. Better, sooner, more convenient: a successful teledermoscopy service. Australas J Dermatol. 2012;53(1):22-5. DOI: 10.1111/j.1440-0960.2011.00836.x. PMID:22309326.
Vestergaard T, Andersen MK, Bygum A. Acceptance of Teledermoscopy by General Practitioners and Dermatologists in Denmark. Dermatol Pract Concept. 2021;11(2):e2021033. DOI: 10.5826/dpc.1102a33. PMID:33954016.
Wilkens J, Thulesius H, Schmidt I, Carlsson C. The 2015 National Cancer Program in Sweden: Introducing standardized care pathways in a decentralized system. Health Policy. 2016;120(12):1378-1382. DOI: 10.1016/j.healthpol.2016.09.008. PMID:27823827.
Drakensjö IRT, Rosen E, Frohm Nilsson M, Girnita A. Ten-year Follow-up Study of Grenz Ray Treatment for Lentigo Maligna and Early Lentigo Maligna Melanoma. Acta Derm Venereol. 2020;100(17):adv00282. DOI: 10.2340/00015555-3631. PMID:32926174.
Cancer Council Victoria and Department of Health Victoria 2021. Optimal care pathway for people with melanoma. Second edition. Accessed June, 2021. https://www.cancer.org.au/assets/pdf/melanoma-optimal-cancer-care-pathway
Pacifico MD, Pearl RA, Grover R. The UK Government two-week rule and its impact on melanoma prognosis: an evidence-based study. Ann R Coll Surg Engl. 2007;89(6):609-15. DOI: 10.1308/003588407x205459. PMID:18201477.
Wikstrom JD, Lundeberg L, Frohm-Nilsson M, Girnita A. Differences in cutaneous melanoma treatment and patient satisfaction. PLoS One. 2018;13(10):e0205517. DOI: 10.1371/journal.pone.0205517. PMID:30359387.
Morton CA, Downie F, Auld S, et al. Community photo-triage for skin cancer referrals: an aid to service delivery. Clin Exp Dermatol. 2011;36(3):248-54. DOI: 10.1111/j.1365-2230.2010.03960.x. PMID:21070338.
Sunderland M, Teague R, Gale K, Rademaker M, Oakley A, Martin RCW. E-referrals and teledermatoscopy grading for melanoma: a successful model of care. Australas J Dermatol. 2020;61(2):147-151. DOI: 10.1111/ajd.13230. PMID:32064590.
Baade PD, English DR, Youl PH, McPherson M, Elwood JM, Aitken JF. The relationship between melanoma thickness and time to diagnosis in a large population-based study. Arch Dermatol. 2006;142(11):1422-7. DOI: 10.1001/archderm.142.11.1422. PMID:17116832.
Berwick M. Evaluating early detection in the diagnosis of melanoma. Arch Dermatol. 2006;142(11):1485-6. DOI: 10.1001/archderm.142.11.1485. PMID:17116841.
Tejera-Vaquerizo A, Cañueto J, Toll A, et al. [Estimated Effect of COVID-19 Lockdown on Skin Tumor Size and Survival: An Exponential Growth Model]. Actas Dermosifiliogr (Engl Ed). 2020;111(8):629-638. DOI: 10.1016/j.ad.2020.05.001. PMID:32513393.
McKenna DB, Lee RJ, Prescott RJ, Doherty VR. The time from diagnostic excision biopsy to wide local excision for primary cutaneous malignant melanoma may not affect patient survival. Br J Dermatol. 2002;147(1):48-54. DOI: 10.1046/j.1365-2133.2002.04815.x. PMID:12100184.
Conic RZ, Cabrera CI, Khorana AA, Gastman BR. Determination of the impact of melanoma surgical timing on survival using the National Cancer Database. J Am Acad Dermatol. 2018;78(1):40-46.e7. DOI: 10.1016/j.jaad.2017.08.039. PMID:29054718.
Garbe C, Peris K, Soura E, et al. The evolving field of Dermato-oncology and the role of dermatologists: Position Paper of the EADO, EADV and Task Forces, EDF, IDS, EBDV-UEMS and EORTC Cutaneous Lymphoma Task Force. J Eur Acad Dermatol Venereol. 2020;34(10):2183-2197. DOI: 10.1111/jdv.16849. PMID:32840022.
Fee JA, McGrady FP, Rosendahl C, Hart ND. Dermoscopy Use in Primary Care: A Scoping Review. Dermatol Pract Concept. 2019;9(2):98-104. DOI: 10.5826/dpc.0902a04. PMID:31106011.
Published
Issue
Section
License
Copyright (c) 2022 Karina Schultz, Lina U Ivert, Jan Lapins, Karin Sartorius, Emma K Johansson
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
Dermatology Practical & Conceptual applies a Creative Commons Attribution License (CCAL) to all works we publish (http://creativecommons.org/licenses/by-nc/4.0/). Authors retain the copyright for their published work.
How to Cite
Share
