92 CHAPTER 5 lower percentage of patients with (pre)malignant diagnosed skin lesions (n=873, 20.5%) and a slightly higher percentage of patients with benign diagnosed skin lesions (n=3384, 79.5%). In these 3 teledermoscopy studies, all patients with suspicious skin lesions, along with patients that the GPs initially would have referred for a physical dermatological consultation, were included. By contrast, in our study, which was performed in daily general practice, GPs acted as gatekeepers to dermatology care. GPs decided themselves whether to apply teledermoscopy, justify a wait-and-see policy, manage the skin condition themselves, or refer the patient to a dermatologist. Previous findings show that teledermoscopy is especially valuable for the triage of patients with benign skin lesions. The relatively fast TD assessment of skin lesions diagnosed as evidently benign reassures and avoids nervous waiting for both patients and practitioners [15,16]. Teledermoscopy also releases the burden on dermatology care since most patients with benign skin lesions can be managed appropriately in GP practice without the need for a physical referral to a dermatologist [5-11]. Moreover, this means that dermatologists can allocate more time to the treatment of patients with complex skin lesions. In addition, patients with severe (pre)malignant skin lesions who need an urgent in-person dermatological evaluation will have improved access to the dermatologist due to the availability of teledermoscopy [5,10,11]. Remarkably, the GPs in our study also applied teledermoscopy to request TD advice concerning nonpigmented benign diagnoses, such as eczema, psoriasis, and insect bites, which is in accordance with 2 other teledermoscopy studies in a virtual lesion clinic and primary health care center setting [9,10]. This implies that GPs also use teledermoscopy as a diagnostic tool to request advice from the TD regarding the management of nonpigmented skin lesions. Dermatologists do not need a dermoscopic photo to assess these types of skin lesions. However, we could not check whether the GPs uploaded a dermoscopic photo for these nonpigmented skin lesions in the teledermoscopy consultation. The teledermoscopy service evaluated in our study is unique compared to other systems because it asks GPs to enter their initial referral decision at the start of the teledermoscopy consultation request and their final referral decision after the teledermoscopy consultation. In a retrospective teledermoscopy study by our research group 5 years ago in the same nationwide context and with the same Dutch teledermoscopy system, we found that the GPs adjusted their initial referral decision after teledermoscopy in half of the consultations [13]. GPs thus still frequently change their referral decision after a teledermoscopy consultation, which could be because they face difficulties when diagnosing skin lesions or discriminating between benign and malignant skin lesions [1,2,6,17]. GPs might lack this knowledge because dermatology education and skills such
RkJQdWJsaXNoZXIy MTk4NDMw