87 TO REFER OR NOT TO REFER IN TELEDERMOSCOPY Ethical considerations No ethical approval was required to evaluate the number of teledermoscopy consultations, since all GPs gave permission through a contract with Ksyos to monitor teledermoscopy quality with these self-administered questions. Study design For this retrospective database study, teledermoscopy consultations requested by GPs between July 2015 and June 2020 were included in the data analysis. Next, consultations with missing values were excluded. Missing values in the database were defined as a TD report of “no diagnosis” (R69), “no abnormalities” (R68.8), or “nonassessable” (−), or if a GP had not answered both self-administered questions. Data acquired included (1) answers to the GP self-administered questions on referral of a patient to a dermatologist and (2) diagnosis provided by TD during the teledermoscopy consultation. Optional differential diagnoses provided by the TD were omitted from this study. Types of cameras or digital dermoscope used to obtain the images were unknown. The GP self-administered questions were used to define whether the GPs had or had not adjusted their initial decision to refer a patient to a dermatologist after reviewing the advice and diagnosis of the TD. In this study, 3 diagnosis groups were defined based on the TD diagnoses and the corresponding ICD-10 codes: malignant, premalignant, and benign. The histopathology and face-to-face diagnoses were not available in our study. Malignant skin lesions included all malignant neoplasms (ICD-10 codes C00-C97) such as melanoma, basal cell carcinoma, and squamous cell carcinoma. Premalignant skin lesions were defined as a separate group and included in situ neoplasms (ICD-10 codes D00-D09), other specified epidermal thickening (ICD-10 code L85.8; e.g., keratoacanthomas), and actinic keratosis (ICD-10 code L57.0). Benign skin lesions included the remaining ICD-10 diagnoses. In this group, we specifically focused on seborrheic keratosis (ICD-10 code L82) and vascular lesions (ICD-10 codes D18, I78.1). For each diagnosis group, the GP self-reported initial and final referral decisions were analyzed. RESULTS Overall cohort In total, 13,509 teledermoscopy consultations requested by 1185 GPs between July 2015 and June 2020 were provided with a diagnosis by 140 TDs. Of these, 1770 (13.1%) were assessed by the TD as “no diagnosis,” 14 (0.1%) as “no abnormalities,” and 350 (2.6%) as “nonassessable.” Moreover, 5011 (44.1%) teledermoscopy consultations had an absent response to the GP self-administered question(s) and were therefore excluded as a missing value from the data set (Figure 5.1). For 6364 (55.9%) of the 11,375 teledermoscopy consultations with an ICD-10 TD diagnosis code, both nonmandatory self-administered 5
RkJQdWJsaXNoZXIy MTk4NDMw