Rates of melanoma are increasing faster than any other common cancer and getting the diagnosis right is a real challenge for GPs.
According to the British Association of Dermatologists, most physicians have “limited experience of melanoma (and) the majority have not had the opportunity to develop diagnostic skills”. As a result, a substantial number of benign lesions are being referred inappropriately to secondary care – “up to 19 out of 20 in some areas”. Conversely, one in three patients with melanoma are initially misdiagnosed by their GP, leading to serious delays in treatment.
NICE guidelines hint at a possible solution, advising GPs that urgent local investigations may be necessary in respect of “patients with less typical symptoms” of cancer. However, until recently, little was done to assist GPs locally with the diagnosis of melanoma.
Digital dermoscopy and melanoma diagnosis
Dermoscopy is skin imaging using a special hand held skin contact microscope. Recommended by NICE guidance for melanoma diagnosis, dermoscopy “yields greater diagnostic accuracy than naked eye examination” although its use should be restricted to experts in the technique.
Scansol, a London based independent acute hospital registered by the Care Quality Commission for skin cancer screening, diagnosis and treatment, has developed TeleDerm - the UK’s first dermoscopic investigation service for GPs.
Winner of the Primary Care category of The Patient Safety Awards 2010, the service enables a GP or practice nurse to record patient history and images, including a dermoscopic image, onto a secure web based electronic patient record. According to the Care Quality Commission the EPR is an example of “commendable practice”.
Patient history and images are then investigated and results are issued to GPs within three days.
Hastings and Rother NHS was the first PCT in the UK to offer TeleDerm to its GPs, having successfully piloted the service from October 2008 to March 2009. 135 GPs in that area now have the option of referring patients with a pigmented lesion or mole showing less typical symptoms that might be due to cancer to a local nurse rather than directly and routinely to secondary care. The nurse records patient data and images on the TeleDerm EPR for dermoscopic investigation and reporting by Scansol’s experts.
To date, GPs using the service to support their clinical decision have increased their diagnostic accuracy, successfully discharging 75 per cent of patients with benign lesions who would otherwise have been referred routinely to hospital and achieving a cost saving to the PCT of 50 per cent per patient. In addition, GPs have increased their diagnostic accuracy for melanoma from less than 50 per cent to 100 per cent.