193 GENERAL DISCUSSION follow-up and histopathologically confirmed diagnoses may be attained by linking data of digital dermatology databases with other national databases such as the Netherlands Cancer Registry [40], healthcare insurance expenses database (Vektis) [41], or the Netherlands Institute for Health Service Research Primary Care Database (NIVEL) [42]. These linkages could likewise provide insight into referral management of patients with skin lesions by GPs not using digital dermatology care. It would also allow us to verify which patients who received a digital dermatology consultation have a histopathology confirmed skin cancer diagnoses or which diagnosis was given by the dermatologist after physical examination of the patient. By matching, for example, the cases found in the Netherlands Cancer Registry with the skin lesions evaluated via digital dermatology, we would be able to compare histopathology outcomes with the provided diagnoses and management plans after TD assessment. However, for melanoma cases, we found in an exploratory study protocol phase of our research group that it would take years of data collection to have a dataset that is extensive enough to draw valid conclusions and to rule out that no melanomas are missed after TD assessment. A similar database matching study was performed by an Estonian study [43]. In this study, they compared the melanoma (ICD: C43) or melanoma in situ (ICD: D03) histopathology confirmed diagnoses from the national health information system with the examinations registered in the national teledermoscopy database. This study showed that 5389 teledermoscopy consultations were required to match 22 of the 50 melanomas from their national health information system with the national teledermoscopy database. We expect that, despite the fact that we have 3.5 times more teledermoscopy consultations in our database, the number of melanoma matches in our dataset with the Netherlands Cancer Registry might even be lower because the Dutch College of General Practitioners (NHG) guideline for management of suspicious skin abnormalities and telemedicine organization policy state that GPs should not use digital dermatology for melanoma cases but immediately refer these patients to a dermatologist [9]. Post COVID-19 scenario During the COVID-19 pandemic in the Netherlands, patients were hesitant to physically contact their GP’s practice because physical contact was not allowed within a range of 1.5 meters and because of the risk of exposure to the corona virus. As a result, fewer patients visited the GP and dermatologist and fewer patients were diagnosed with skin cancer compared to a similar period before the pandemic [44-46]. Dermatology home consultation, teledermatology and teledermoscopy provided opportunities to diagnose patients virtually during the pandemic and to mitigate the number of physical visits in GP practices and hospitals. Future studies should examine whether the type of skin conditions assessed via digital dermatology during the pandemic also differed compared to the prepandemic period. 8
RkJQdWJsaXNoZXIy MTk4NDMw