Abstract | November 10, 2020

Inpatient Dermatology Consultations for Suspected Skin Cancer: A Retrospective Review

Presenting Author: Katie A O'Connell, MS, BA, Medical Student (Current Research Fellow between MS3 & MS4), School of Medicine, Eastern Virginia Medical School, Norfolk, VA

Co-authors: Scott Whitlock, MD, Chief Resident, Department of Dermatology, EVMS, Norfolk, VA; Arjun Saini, MD, Resident, Department of Dermatology, Howard University, Washington D.C.; Thomas Michael Pender, MS, Medical Student, MS4, EVMS, Norfolk, VA; Abby Van Voorhees, MD, Chair, Department of Dermatology, EVMS, Norfolk, VA

Learning Objectives

  1. Following this presentation, attendees will recognize the importance of in-patient dermatology consultation for suspected cutaneous malignancy.
  2. Following this presentation, attendees will be able to describe the characteristics of cutaneous malignancies identified at this academic, tertiary medical center.

Background: Dermatologists are consulted in the inpatient setting to rule out possible skin cancer. This provides an opportunity to identify and treat cutaneous malignancy, often in patients who may not have sought outpatient dermatologic care.

Goals: Seeking to better understand the nature of these patient encounters, we reviewed all consults for which the referring physician suspected skin cancer.

Methods: We conducted a retrospective review of inpatient dermatology referrals at an academic-affiliated, tertiary medical center. We identified all patients with an inpatient dermatology consult for suspected skin cancer or “skin lesion” between 07/01/13-07/01/19. We collected patients’ sex, age at time of consult, race, specialty of referring provider, lesion location, lesion maximum diameter, whether a biopsy was performed, inpatient vs outpatient setting for biopsy, clinical diagnosis, histopathologic diagnosis, and subsequent treatment.

Results: Consults were received from many specialties (12 total). 47 total lesions in 38 patients were identified, with the majority on the head and neck (66%). Of 38 total patients referred for possible skin cancer, 20 were found to have at least one pathology-confirmed cutaneous malignancy (23 total tumors). Of these, 10 were basal cell carcinoma, 11 squamous cell carcinoma, 1 malignant melanoma, and 1 anaplastic T-cell lymphoma. 17 of the 23 tumors were ≥2.0 cm in diameter at the time of biopsy (74%). Subsequently performed treatments for these patients included wide local excision (3), Mohs micrographic surgery (5), radiation (3), topical fluorouracil (1), electrodessication and curettage (4), and chemotherapy/immunotherapy (2).

Conclusion: About half of the consultations for cutaneous malignancies resulted in a skin cancer diagnosis. Patients in this population were admitted to the hospital for a variety of diagnoses, most unrelated to their cutaneous malignancy, suggesting that the inpatient setting offers the opportunity to identify skin cancer which may otherwise be unaddressed. This study highlights the surprising number of large diameter, high risk tumors identified.

Posted in: Medical Oncology17 Medicine & Medical Specialties21 Skin Cancer2