Outcomes of Referral to Dermatology for Suspicious Lesions: Implications for Teledermatology
Abstract
OBJECTIVES: To determine the proportion of suspicious lesions referred by nondermatologists that are found to be malignant and the number of incidental skin cancers identified at the time of dermatology referral. DESIGN: Retrospective cohort study. SETTING: Veterans Affairs Connecticut Healthcare System. PATIENTS: Four hundred patients referred by nondermatologists for skin lesions suspected of being malignant between January 1, 2006, through December 31, 2009. MAIN OUTCOME MEASURES: Data collected included the type of referring provider, the final diagnosis by the dermatologist, and the number and type of incidental lesions. RESULTS: Only 22.0% of the index lesions (ie, the lesions that prompted the referral) were found to be cancerous. In aggregate, 149 cancerous lesions were noted in 98 patients. However, only 88 (59.1%) were identified in the index lesion; 111 incidental lesions were biopsied by the consulting dermatologist, with 61 (55.0%) additional skin cancers identified. Twelve of the 61 incidental cancers (19.7%) were found in patients whose index lesion was clinically benign and was not biopsied. CONCLUSIONS: Nondermatologists may benefit from focused educational initiatives on skin cancer detection, particularly the significance of the total body skin examination and the expectations for and limitations of teledermatology. A substantial proportion of malignant lesions was incidentally identified by the consulting dermatologist in addition to the primary lesion of concern. The use of teledermatology to assess a specific lesion of concern may be associated with underdiagnosis of clinically significant lesions that are not appreciated by the referring physician. Therefore, teledermatology must not be used as a substitute for a total body skin examination.
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Nonspecialists play a pivotal role in the assessment of skin lesions and initiation of clinical management and referrals.
“nonspecialists play a pivotal role in the assessment of skin lesions and initiation of clinical management and referrals.7”
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- Authors
- Viola, K. V., Tolpinrud, W. L., Gross, C. P., Kirsner, R. S., Imaeda, S., & Federman, D. G.
- Affiliations
- Yale University (US)
- United States Department of Veterans Affairs (US)
- Venue
- Archives of Dermatology
- Publisher
- American Medical Association (AMA)
- Published
- 2011-05-16
- Volume
- 147
- Issue
- 5
- Pages
- 556
- ISSN
- 0003-987X (ISSN-L)
- OpenAlex
- W2094470872
- Semantic Scholar
- e6432b746c025d64eaa88458171c04cca6f3149e
- Cited by
- 72
- References
- 24
- Citations by year
- 2026: 1 · 2025: 2 · 2024: 2 · 2023: 8 · 2022: 3 · 2021: 5 · 2020: 10 · 2018: 7 · 2017: 4 · 2016: 2 · 2015: 8 · 2014: 3 · 2013: 9 · 2012: 6
- FWCI
- 3.15
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Archives of Dermatology (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Oncology › Cutaneous Melanoma Detection and Management
- Health Sciences › Medicine › Epidemiology › Nonmelanoma Skin Cancer Studies
- Health Sciences › Medicine › Dermatology › Cancer and Skin Lesions
- Keywords
- skin cancer, suspicious skin lesions, dermatology referral, teledermatology, total body skin examination, skin cancer detection, underdiagnosis, veterans
- MeSH terms
- Aged, Aged, 80 and over, Biopsy, Carcinoma, Basal Cell, Basal Cell Carcinoma, Carcinoma, Squamous Cell, Dermatology, Female, Humans, Male, Melanoma, Middle Aged, Referral and Consultation, Skin Neoplasms, Telemedicine
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