Urgent access to a specialty care melanoma clinic is associated with a higher rate of melanoma detection

作者：Lipworth Adam D; Park Jong Min; Trefrey Brie L; Rubin Krista M; Geller Alan C; Sober Arthur J; Tsao Hensin^*

来源：Journal of the American Academy of Dermatology, 2011, 64(6): 1060-1067.

DOI：10.1016/j.jaad.2010.08.021

• detection
• melanoma
• pigmented lesion
• pigmented lesion clinic
• routine visit
• urgent access
• urgent access track

Background: As melanoma rates increase, and the supply of dermatologists remains suboptimal to meet demand for services, detection of early melanoma has become an increasingly difficult challenge. Some authors advocate for shifting dermatologic resources from routine appointments to urgent visits for those With lesions concerning for melanoma.
Objective: We sought to investigate the potential of an urgent access track (UAT) embedded within a pigmented lesion clinic to improve early melanoma detection.
Methods: We conducted a retrospective review of patient records from a tertiary care hospital's pigmented lesion clinic and the associated UAT.
Results of procedures for all 4495 patient visits to the routine track and all 316 visits to the UAT during the 21-month study period were included, as were detailed chart reviews of all UAT patient visits. Results: UAT visits were more than 4 times as likely (4.1% vs 1.0%) to yield a diagnosis of melanoma as routine track visits (odds ratio 4.24; 95% confidence interval 2.28-7.88; P < .0001), and almost 25 times as likely (2.2% vs 0.1%) to yield a diagnosis of metastatic melanoma (odds ratio 25.4; 95% confidence interval 7.4-87.4; P < .0001).
Limitations: This was a preliminary analysis with only limited data extracted from the routine track pigmented lesion clinic patient visits.
Conclusion: This initial analysis of UAT strategy suggests that UATs have potential to detect patients with earlier melanomas; further research is needed to specifically delineate how resources should be best allocated between routine surveillance and urgent care to maximize melanoma early detection and survival. (J Am Acad Dermatol 2011;64: 1060-7.)

• 出版日期2011-6