title: Teledermatology-directed surgical care is safe and reduces travel.
abstract: METHODS
  We conducted a retrospective chart review and identified 186 Veterans in the VA Corporate Data Warehouse as having malignant melanomas or severely dysplastic nevi during the four-year period of observation from 1 July 2009 to 30 June 2013 and met inclusion and exclusion criteria for analysis.
  
  
  RESULTS
  Three hundred and sixty-six surgical procedures were performed for diagnosis and treatment of these conditions including biopsy and wide-local excision, of which 189 carefully selected cases were performed by primary care clinicians with 2.0% biopsy complication rate and a 7.7% wide-local excision complication rate. Cases not performed by primary care providers were referred to specialists (e.g. dermatologists, general surgeons or specialty surgeons) who had a 2.5% complication rate in biopsies and wide-local excision complication rate of 13.5% in severely dysplastic nevi and pTis and pT1a lesions and a 10.7% complication rate for lesions pT1b and greater.
  
  
  CONCLUSIONS
  These results show that a significant fraction of surgical procedures for diagnosis and treatment of malignant melanoma and severely dysplastic nevi can be safely performed in rural clinics by trained primary care providers.
authors.affiliation: VA Puget Sound Health Care System, Seattle Division, USA.
authors.forename: Kirtana
authors.initials: K
authors.lastname: Vedire
authors.affiliation: VA Puget Sound Health Care System, Seattle Division, USA Tulane University School of Medicine, New Orleans, USA.
authors.forename: Andrew L
authors.initials: AL
authors.lastname: Joselow
authors.affiliation: VA Puget Sound Health Care System, Seattle Division, USA.
authors.forename: Craig M
authors.initials: CM
authors.lastname: Markham
authors.affiliation: VA Puget Sound Health Care System, Seattle Division, USA University of Washington, Department of Medicine (Dermatology), Seattle, USA gregory.raugi@va.gov.
authors.forename: Gregory J
authors.initials: GJ
authors.lastname: Raugi
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003880:Dermatology / Q000379:methods*; D004416:Dysplastic Nevus Syndrome / Q000175:diagnosis / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008545:Melanoma / Q000175:diagnosis / Q000601:surgery*; D008875:Middle Aged; D061214:Patient Safety; D011183:Postoperative Complications; D012189:Retrospective Studies; D012878:Skin Neoplasms / Q000175:diagnosis / Q000601:surgery*; D017216:Telemedicine / Q000592:standards*; D014195:Travel / Q000706:statistics & numerical data*; D014728:Veterans; D000096142:Cutaneous Malignant Melanoma
keywords: Telemedicine; melanoma; primary care clinicians; severely dysplastic nevi; teledermatology