Original articleThe role of accessibility policies and other determinants of health care provision in the initial prognosis of malignant melanoma: A cross-sectional study
Section snippets
Methods
TEDIMEL-A was a multicenter, cross-sectional study conducted at hospitals belonging to the Public Health System of Andalusia (PHSA), a region in southern Spain (Table I). Cases of primary in situ MM (Tis) or invasive cutaneous MM diagnosed between January 1, 2000, and December 31, 2009 were included in the study after verifying that the MMs failed to meet the following exclusion criteria: second primary MM, lack of Breslow thickness in the pathology report, and primary MM pathologically
Results
The dermatology and pathology units of 14 hospitals belonging to the PHSA and representative of the various hospital types, demographic features, and geographic features of the region participated in the study (Table I). The population covered by the participating centers numbered 5,422,660 inhabitants, which represents 64.18% of the total population of Andalusia (n = 8,449,265 in 2009; Table I).5 The number of cases of MM included by each of the participating centers during the 10-year study
Discussion
The TEDIMEL-A project has served to document the increasing frequency of MM diagnosis between 2000 and 2009 in Andalusia, the second largest region of Spain (87,590 km2). Considering the slight increase observed in T2-T4 tumors, the rising frequency of MMs might be primarily explained by the increase in the diagnosis of Tis-T1 tumors (Fig 2).5 This rising frequency in the diagnosis of melanoma, combined with the steady mortality of melanoma observed in recent decades, has prompted extensive
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Direct-to-consumer, store-and-forward teledermatology with dermoscopy using the pharmacist as patient point-of-contact
2021, Journal of the American Pharmacists AssociationCitation Excerpt :Teledermatology with dermoscopy has been shown to improve the results of an Internet-based skin cancer screening system, as compared with screening systems based on the use of clinical images alone.4 Both the proximity and reliability of teledermatology with dermoscopy improve accessibility to specialized care, which can explain the increasing frequency with which thin melanomas (Tis-T1)5 are identified; this represents an early diagnosis, which is associated with a better prognosis. Since September 2017, we have been employing a “direct-to-consumer,” store-and-forward teledermatology with dermoscopy model in the private setting at the Viamed Santa Angela de la Cruz Hospital in Seville in collaboration with Bidafarma (Figure 1).
Practice Models in Teledermatology in Spain: Longitudinal Study, 2009-2014
2018, Actas Dermo-SifiliograficasCitation Excerpt :Store-and-forward TD has been shown to be effective in reducing the number of face-to-face consultations in hospitals.15 Face-to-face consultations and store-and-forward TD have shown similar results in terms of clinical improvement and time to intervention in patients with skin cancer.3,16 In recent years, there has been a considerable increase in the number of successful TD programs for managing skin cancer13 and for providing a rapid response in large urban areas.9
Use of Lymph Node Ultrasound Prior to Sentinel Lymph Node Biopsy in 384 Patients with Melanoma: A Cost-Effectiveness Analysis
2017, Actas Dermo-SifiliograficasCitation Excerpt :This cost represents a 0.96% increase in the cost of staging patients with melanoma and is an additional cost that can be considered acceptable for most health services, especially if we take into account the low-to-medium incidence of melanoma in Spain (8.76; 95% CI, 7.50-10.02).23 Thus, in the case of a hospital with a reference population of 500 000 inhabitants and an expected incidence of 40-50 cases/year and assuming that 50% of cases are diagnosed as melanoma in situ or T1, with no indication for SLNB, the inclusion of ultrasound during initial staging would represent an annual total extra cost of between €350 and €450, which most health services can afford.23,24 In addition, the cost of performing ultrasound on all of the patients (n = 384) and the lymph node biopsies performed to confirm ultrasound findings suspected of being malignant (n = 104) was partially compensated by the 23 SLNBs avoided (€42 560 vs €39 100).
The Trends in Melanoma Diagnosis in Andalusia (TEDIMEL-A) Project Study Group is funded by a competitive public grant of the Health Institute Carlos III of the Spanish Health Ministry (IP 10-1929 2010-2013).
Conflicts of interest: None declared.
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