[Successful regional teledermatological and teledermatoscopic triage networking between general practitioners and dermatologists]. / Erfolgreiche regionale teledermatologische und teledermatoskopische Triage-Vernetzung zwischen niedergelassenen Hausärzten und Hautärzten.

BACKGROUND: There is an increasing need by general practitioners (GPs) for consultations regarding skin diseases or skin lesions. Teledermatological and teledermoscopic diagnoses are possible with good results. OBJECTIVES: This descriptive study analyzed whether the increasing need for dermatological consultations could be improved by regional teledermatological and teledermoscopic triage between GPs and dermatologists. MATERIALS AND METHODS: Via an internet platform, six GPs sent images of unclear skin diseases or skin lesions to a dermatology practice (2 dermatologists) over a period of 9 months. Possible triage answers were (1) stay at the GP, (2) urgent consultation at the dermatologist (days), or (3) later (week/months) consultation at the dermatologist, respectively, with the diagnosis and therapeutic suggestions. A feedback (grade 1-6) were given by the dermatologists about the image quality and from the GPs about the appraisal. The dermatologists' appraisals were done independently and were audited by a third dermatologist. RESULTS: The patients' acceptance was 100% and a very good to good image quality was achieved in 94%; 66.3% of patients could stay at their GP and 20.7% of patients should come urgently to the dermatologist. The teletriage decisions of an urgent consultation at the dermatologist were confirmed in 41.5%. The GPs' feedback about the teletriage appraisal received an overall average grade of 1.1. CONCLUSION: Successful regional teledermatological and teledermoscopic triage between GPs and dermatologists is possible. Specifications on data privacy laws must be followed and an appropriate remuneration is preferable.

Advanced cutaneous squamous cell carcinoma: A retrospective analysis of patient profiles and treatment patterns-Results of a non-interventional study of the DeCOG.

BACKGROUND: Advanced cutaneous squamous cell carcinoma (aSCC) is an area of unmet medical need and no treatment standards are established. Recently, an anti-PD-1 inhibitor received FDA breakthrough therapy designation. The aim of the study was to describe the clinical course, therapeutic management and prognosis of aSCC under real-life conditions. PATIENTS AND METHODS: In a retrospective study performed in 24 German and Austrian hospitals and doctor's offices, patient and tumour characteristics of patients diagnosed with aSCC between January 1, 2010 and December 31, 2011 and their disease course was documented. Advanced SCC comprised either locally advanced SCCs (laSCC) or metastatic SCCs (mSCC) with any kind of metastatic spread. RESULTS: Data of 190 patients with aSCC were analysed. Median age at time of diagnosis of aSCC was 78 years. LaSCC was diagnosed in 76 patients (40%), 114 patients (60%) had mSCC. Once diagnosed with laSCC, most patients (59%) did not receive any therapy, whereas in 92% of mSCC patients at least one type of therapy was performed. Only 32 patients (29 mSCC, 3 laSCC) received systemic antitumour therapies, mostly EGFR inhibitor-based regimens. Mean duration of response was short (17-months laSCC patients, 3-months mSCC patients). Only 2 patients achieved a complete response, 27% had a partial response, 43% disease stabilisation. At diagnosis of aSCC, ECOG status was 0-1 in most patients. Non-malignant comorbidities influenced the decision on SCC-specific therapy in 39 patients (21%). CONCLUSIONS: Our data show the high medical need for efficient and tolerable antitumour therapies and demonstrate that despite older age and comorbidities, most patients can be expected to be fit for treatment. This study provides a historical context for emerging aSCC treatments.

Dermoscopic appearance of an amelanotic mucosal melanoma.

BACKGROUND: Hypomelanotic or amelanotic melanomas are challenging to identify, especially at mucosal sites. The dermoscopic clues to the diagnosis of mucosal melanomas have been reported to be structureless zones with the presence of blue, gray, or white colors. CASE: A female in her seventies noted a new lesion on the inside of her right labia that first appeared two months prior. Her past medical history was significant for rheumatoid arthritis requiring ongoing treatment with methotrexate for 20 years and adalimumab for 10 years. After no response to two weeks of local treatment for suspected herpes simplex infection, her gynecologist performed a skin biopsy. Based on the histopathological diagnosis of an amelanotic melanoma (Breslow thickness of 1.3 mm) the patient was referred to dermatology for further assessment. Polarized dermoscopy revealed a distinct asymmetric, sharply demarcated homogenous white papule (4 × 5 mm) as well as polymorphous vessels. CONCLUSION: Dermoscopy may aid in the diagnosis of amelanotic mucosal melanomas. Our case revealed a structureless white area and polymorphous vessels. Additional clues to the diagnosis were the advanced age of the patient and the clinical presentation of a new lesion.