title: Supply-and-demand discrepancy in academic pigmented lesion clinics: a case for a new health care delivery model.
abstract: OBJECTIVE
  There is an increasing demand for a limited number of pigmented lesion clinic (PLC) visits at dermatology centers.
  
  
  OBJECTIVE
  To determine the proportion of visits to PLCs that are more frequent ("additional screening") than the recommended ("standard") follow-up schedule and to determine if certain patient characteristics correlate with the demand for these visits.
  
  
  METHODS
  A retrospective medical chart review of all PLC visits at an academic dermatology center from October 2010 to January 2012. A total of 609 patients associated with 1756 visits were identified. Of these, 25 patients associated with 26 visits were excluded owing to lack of melanoma diagnosis or risk factors, leaving 584 patients and 1730 visits. Diagnoses of these patients included in situ and invasive melanoma, dysplastic nevi, Spitz nevi, atypical nevus syndrome, family history of melanoma only, and other risk factors. The mean (SD) age was 48 (16) years, and 235 (40.2%) of the patients were male.
  
  
  METHODS
  The proportion of additional screening visits compared with standard visits. Standard visits were defined as occurring at the following frequencies: annually for mildly dysplastic nevi, Spitz nevi, or solely family history of melanoma; biannually for the first year, then annually thereafter for moderately dysplastic nevi or atypical nevus syndrome; biannually for up to 3 years, then annually thereafter for severely dysplastic nevi or melanomas in situ; every 3 months for 2 years, biannually for the following 2 years, then annually thereafter for invasive melanoma.
  
  
  RESULTS
  A total of 1400 visits (80.9%) were standard, 257 (14.9%) were for additional screening, and 73 (4.2%) were "problem focused." Thirty percent of patients had at least 1 additional screening visit. The distribution of diagnoses among standard vs additional screening visits differed significantly, with "family history only" and "other risk factors" taking up a larger percentage of standard visits (15.1%) than the percentage of additional screening visits (8.9%), and all other diagnoses being better represented among additional screening visits (P = .04). No particular patient characteristic described those who sought additional screening visits.
  
  
  CONCLUSIONS
  A substantial proportion of additional screening PLC visits exist and are desired by all patients with pigmented lesions. We propose alternative clinic models, such as diagnosis-specific, adjunctive fee-for-additional-service, and teledermatology clinics to meet patient needs while creating resources to expand PLC visits.
authors.affiliation: Department of Dermatology, Emory University, Atlanta, Georgia.
authors.forename: Erin L
authors.initials: EL
authors.lastname: Vickery
authors.affiliation: Department of Dermatology, Emory University, Atlanta, Georgia.
authors.forename: Elizabeth M
authors.initials: EM
authors.lastname: Seidler
authors.affiliation: Department of Dermatology, Emory University, Atlanta, Georgia2Department of Anesthesiology, University of Florida, Gainesville.
authors.forename: Todd E
authors.initials: TE
authors.lastname: Jones
authors.affiliation: Department of Medicine, Emory University, Atlanta, Georgia4Center for Research and Grants, Baptist Health South Florida, Miami.
authors.forename: Emir
authors.initials: E
authors.lastname: Veledar
authors.affiliation: Division of Dermatology, Department of Dermatology, Atlanta VAMC, Emory University, Atlanta, Georgia.
authors.forename: Suephy C
authors.initials: SC
authors.lastname: Chen
mesh_terms: D000328:Adult; D000368:Aged; D000554:Ambulatory Care Facilities / Q000458:organization & administration; D003695:Delivery of Health Care / Q000458:organization & administration*; D003880:Dermatology / Q000458:organization & administration*; D004416:Dysplastic Nevus Syndrome / Q000175:diagnosis / Q000473:pathology; D005260:Female; D005500:Follow-Up Studies; D006301:Health Services Needs and Demand; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000379:methods; D008545:Melanoma / Q000175:diagnosis* / Q000473:pathology; D008875:Middle Aged; D018332:Nevus, Epithelioid and Spindle Cell / Q000175:diagnosis / Q000473:pathology; D009508:Nevus, Pigmented / Q000175:diagnosis / Q000473:pathology; D009819:Office Visits / Q000706:statistics & numerical data; D012189:Retrospective Studies; D012307:Risk Factors; D012878:Skin Neoplasms / Q000175:diagnosis* / Q000473:pathology; D013997:Time Factors