71 THE VALUE OF TELEDERMOSCOPY TO THE EXPERTISE OF GPS DIAGNOSING SKIN DISORDERS INTRODUCTION Melanoma, a malignant tumor of the skin, evolves fast and is currently recognized as the deadliest type of skin cancer [1,2]. Early recognition and treatment are essential in improving these patient outcomes. When diagnosed in the early phase, melanoma is almost always curable. General practitioners (GPs) have a vital role in detecting and diagnosing melanoma early, as often the first care contact patients visit. However, literature shows that GPs’ expertise in detecting melanoma is insufficient [3-5]. Previous studies showed low agreement between GPs and dermatologists in diagnosing suspicious skin lesions [4,5]. In addition to the inadequacy in melanoma detection, long waiting times before consultation of a dermatologist also limits early melanoma detection. A telehealth service that supports GPs in diagnosing melanoma could be a solution to optimize early detection and access to specialist skin care services. Teledermoscopy consultation is a growing online service for melanoma detection. In teledermoscopy, dermoscopic images (10-30x magnification) are sent via a secured internet connection to a (tele)dermatologist, who examines these suspicious skin lesions online. The (tele)dermatologist then provides a patient’s caregiver with an accurate diagnosis and advice on the need for referral based on the assessment of the dermoscopic images [6]. This service would thus provide the GP with direct feedback on the correctness of their pre-diagnosis of a patient’s skin disorder. Research has shown that GPs’ expertise in melanoma detection increases after training [3] and that fewer melanomas were missed by experienced and trained consultants [6]. It therefore remains a question, whether a telehealth service will also enhance GP’s expertise in melanoma detection after continual system use. Ksyos is a healthcare organization in the Netherlands which provides teledermoscopy consultation between the GP and teledermatologist [7]. While performing teledermoscopy the GP takes an overview, detailed and dermoscopic picture of the suspicious lesion and sends it together with some patient characteristics and a pre-diagnosis in the Ksyos digital health record system to a teledermatologist (TD). The TD assesses the consultation and provides a diagnosis. Recording this diagnosis is mandatory for the TD but optional for the GP. Figure 4.1 gives an overview of this teledermoscopy consultation process. Data from the Ksyos digital health record system shows that GPs indicate that they learned from the teledermoscopy consultations and the total number of teleconsultations per GP is indeed decreasing over time. However, the question is if frequently diagnosing teledermoscopy consultations and exposure to this service increases the expertise of GPs in diagnosing skin lesions after continual use. 4
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