title: Outcomes of referral to dermatology for suspicious lesions: implications for teledermatology.
abstract: OBJECTIVE
  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.
  
  
  METHODS
  Retrospective cohort study.
  
  
  METHODS
  Veterans Affairs Connecticut Healthcare System.
  
  
  METHODS
  Four hundred patients referred by nondermatologists for skin lesions suspected of being malignant between January 1, 2006, through December 31, 2009.
  
  
  METHODS
  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.
authors.affiliation: Robert Wood Johnson Clinical Scholars Program, Yale University School of Medicine, New Haven, Connecticut, USA.
authors.forename: Kate V
authors.initials: KV
authors.lastname: Viola
authors.forename: Whitney L
authors.initials: WL
authors.lastname: Tolpinrud
authors.forename: Cary P
authors.initials: CP
authors.lastname: Gross
authors.forename: Robert S
authors.initials: RS
authors.lastname: Kirsner
authors.forename: Suguru
authors.initials: S
authors.lastname: Imaeda
authors.forename: Daniel G
authors.initials: DG
authors.lastname: Federman
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001706:Biopsy; D002280:Basal Cell Carcinoma / Q000175:diagnosis / Q000473:pathology; D002294:Carcinoma, Squamous Cell / Q000175:diagnosis / Q000473:pathology; D003880:Dermatology; D005260:Female; D006801:Humans; D008297:Male; D008545:Melanoma / Q000175:diagnosis / Q000473:pathology; D008875:Middle Aged; D012017:Referral and Consultation; D012878:Skin Neoplasms / Q000175:diagnosis* / Q000473:pathology; D017216:Telemedicine