Costello, Collin M.

AbstractBackgroundLittle research has been done in teledermatology to examine the effects of standardized templates and subject‐specific learning modules.MethodsWe performed a prospective study examining the effects of standardized templates and standardized cutaneous oncology learning modules on teledermatology referrals at Mayo Clinic. This data was then compared to previous teledermatology referrals before standardized templates were adopted.ResultsA total of 42 teledermatology consultations were performed during the 4‐month study period. The use of standardized templates resulted in an absolute reduction in face‐to‐face referrals. Teledermatology consultation increased the absolute diagnostic and management concordance by 26.2% (P = 0.02) and 33.3% (P < 0.01), respectively, and decreased the absolute diagnostic and management discordance by 19.1% (P = 0.03) and 31.0% (P < 0.01), respectively. The largest knowledge gaps were identified in cutaneous oncology. Educational intervention improved theoretical referral rates and confidence in diagnosis and management overall.ConclusionThe implementation of standardized intake templates reduces the rate of face‐to‐face referrals. Teledermatology improves primary care‐based dermatological care and reduces theoretical referral rates.

Despite well‐defined clinical and histopathological features of melanoma, atypical presentations mimicking other skin disorders can result in a delayed diagnosis or misdiagnosis and subsequent inappropriate treatment. Rosai‐Dorfman disease (RDD) is a rare histiocytic disorder with unique clinical and histopathological features. We report a case of melanoma treated with cryotherapy that mimicked RDD both clinically and histopathologically. We compare this RDD‐like melanoma to classic RDD, outlining the importance of clinicopathological correlation prior to treatment, as well as the potential pitfalls in diagnosis after cryotherapy of pigmented lesions.

AbstractBackgroundThe benign and malignant patterns of acral melanocytic naevi (AMN) and acral melanomas (AM) have been defined in a series of retrospective studies. A three‐step algorithm was developed to determine when to biopsy acral melanocytic lesions. This algorithm has only been applied to a Japanese population.ObjectivesOur study aimed to review the current management strategy of acral melanocytic lesions and to investigate the utility of the three‐step algorithm in a predominately Caucasian cohort.MethodsA retrospective search of the pathology and image databases at Mayo Clinic was performed between the years 2006 and 2016. Only cases located on a volar surface with dermoscopic images were included. Two dermatologists reviewed all dermoscopic images and assigned a global dermoscopic pattern. Clinical and follow‐up data were gathered by chart review. All lesions with known diameter and pathological diagnosis were used for the three‐step algorithm.ResultsRegular fibrillar and ridge patterns were more likely to be biopsied (P = 0.01). The majority of AMN (58.1%) and AM (60%) biopsied were due to physician‐deemed concerning dermoscopic patterns. 39.2% of these cases were parallel furrow, lattice‐like or regular fibrillar. When patients were asked to follow‐up within a 3‐ to 6‐month period, only 16.7% of the patients returned within that interval. The three‐step algorithm would have correctly identified four of five AM for biopsy, missing a 6 mm, multicomponent, invasive melanoma.ConclusionWe found one major educational gap in the recognition of low‐risk lesions with high rates of biopsy of the fibrillary pattern. Recognizing low‐risk dermoscopic patterns could reduce the rate of biopsy of AMN by 23.3%. We identified two major practice gaps, poor patient compliance with follow‐up and the potential insensitivity of the three‐step algorithm to small multicomponent acral melanocytic lesions.