School of Medicine and Health Sciences Poster Presentations

Title

Skin cancer referrals in New Zealand: Teledermatology expediting treatment

Document Type

Poster

Abstract Category

Rehabilitation and Recovery

Keywords

skin neoplasms, melanoma, telemedicine, teledermatology, global health

Publication Date

Spring 5-1-2019

Abstract

BACKGROUND. The rate of skin cancer in New Zealand is the highest in the world, but there is a severe shortage of dermatologists to meet the challenge. Only 2.1 full-time equivalent (FTE) public dermatologists are available to serve over 400,000 residents of the Waikato region of New Zealand. As a result, most patients rely upon general practitioners (GPs), who may have difficulty correctly diagnosing or crafting the most appropriate treatment plan for their lesions. In order to combat the access gap and prioritize skin cancer diagnosis and treatment, Waikato public dermatologists launched the Suspected Skin Cancer (SSC) service, a free store-and-forward teledermatology system for Waikato GPs to receive specialist advice within four days of referral. We conducted a retrospective chart review of the first six months of the SSC service to investigate the accuracy of both GP and dermatologist diagnoses, advice adherence, as well as time to response and action. METHODS. We determined the diagnoses, histopathology, dermatologist response time, advice given, and the subsequent action based on referral letters, clinical letters, primary care records, and histology reports. From this data, we evaluated the broad diagnostic concordance, which was based on the categorization of lesions as benign or cancerous, between physician specialties as well as the rate of advice adherence. A total of 8 referrals were excluded due to referrer error, and 2 were excluded due to pathway error. RESULTS. GPs made 340 referrals for 402 lesions belonging to 310 patients between July to December 2017. Median specialist response time was 0.84 days (range 0.01– 4.90 days). The researchers categorized the diagnoses as cancerous (GP n = 235, dermatologist n = 130) or benign (n = 185, 256). Histopathology of excised lesions revealed 56 cancers, including 19 melanomas, 26 basal cell carcinomas, and 11 squamous cell carcinomas. Of the 402 lesions, broad diagnostic non-concordance was 26% (n = 103, κ = 0.58) between GPs and dermatologists, 26% (n = 18, κ = 0.61) between GPs and pathologists, and 12% (n = 8, κ = 0.81) between dermatologists and pathologists. GPs followed the dermatologists’ treatment advice in 74% (n = 140) of cases when action was recommended. The average time from GP referral to recommended action was 61.7 days. CONCLUSION. Teledermatology is an effective and convenient method for connecting GPs with dermatologists for the rapid and accurate diagnoses and management advice for benign and malignant skin lesions.

Open Access

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Presented at Research Days 2019.

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Skin cancer referrals in New Zealand: Teledermatology expediting treatment

BACKGROUND. The rate of skin cancer in New Zealand is the highest in the world, but there is a severe shortage of dermatologists to meet the challenge. Only 2.1 full-time equivalent (FTE) public dermatologists are available to serve over 400,000 residents of the Waikato region of New Zealand. As a result, most patients rely upon general practitioners (GPs), who may have difficulty correctly diagnosing or crafting the most appropriate treatment plan for their lesions. In order to combat the access gap and prioritize skin cancer diagnosis and treatment, Waikato public dermatologists launched the Suspected Skin Cancer (SSC) service, a free store-and-forward teledermatology system for Waikato GPs to receive specialist advice within four days of referral. We conducted a retrospective chart review of the first six months of the SSC service to investigate the accuracy of both GP and dermatologist diagnoses, advice adherence, as well as time to response and action. METHODS. We determined the diagnoses, histopathology, dermatologist response time, advice given, and the subsequent action based on referral letters, clinical letters, primary care records, and histology reports. From this data, we evaluated the broad diagnostic concordance, which was based on the categorization of lesions as benign or cancerous, between physician specialties as well as the rate of advice adherence. A total of 8 referrals were excluded due to referrer error, and 2 were excluded due to pathway error. RESULTS. GPs made 340 referrals for 402 lesions belonging to 310 patients between July to December 2017. Median specialist response time was 0.84 days (range 0.01– 4.90 days). The researchers categorized the diagnoses as cancerous (GP n = 235, dermatologist n = 130) or benign (n = 185, 256). Histopathology of excised lesions revealed 56 cancers, including 19 melanomas, 26 basal cell carcinomas, and 11 squamous cell carcinomas. Of the 402 lesions, broad diagnostic non-concordance was 26% (n = 103, κ = 0.58) between GPs and dermatologists, 26% (n = 18, κ = 0.61) between GPs and pathologists, and 12% (n = 8, κ = 0.81) between dermatologists and pathologists. GPs followed the dermatologists’ treatment advice in 74% (n = 140) of cases when action was recommended. The average time from GP referral to recommended action was 61.7 days. CONCLUSION. Teledermatology is an effective and convenient method for connecting GPs with dermatologists for the rapid and accurate diagnoses and management advice for benign and malignant skin lesions.