Original Article

Nondermatologists' Use of Predictive Terms for a Potentially Malignant Lesion

Authors: Whitney L. Tolpinrud, BA, Kate V. Viola, MD, Robert Scott Kirsner, MD, PhD, Cary P. Gross, MD, Suguru Imaeda, MD, Daniel G. Federman, MD, FACP

Abstract

Background: Skin cancer is frequently suspected by nondermatologists. Many dermatology practices currently do not triage referrals from nondermatologists. Little is known how nondermatologists describe lesions of concern when making referrals.


Objective: We sought to assess the descriptive terminology used by nondermatologists when referring patients with potential cutaneous malignancies.


Methods: We completed a retrospective chart review of 400 patients referred by nondermatologists for skin lesions suspicious of malignancy. We collected the reason for the consult, all terminology used to characterize the lesion, and the final diagnosis.


Results: Clinicians documented 680 reasons for referring patients with suspicious lesions.General concern (rule out malignancy) without specific descriptors was used in 78 referrals, of which 23% (n = 18) were found to be associated with malignancy. Specific descriptive terminologies used most frequently by nondermatologists to describe suspicious lesions were: hyperpigmented (n = 71), changing size (n = 69), nonhealing (n = 55), irregular border(n = 52), irritated and/or scaly (n = 40), and raised (n = 33). A statistically significant correlation (P < 0.05) was found between skin cancer and the following terms: nonhealing,ulcerated, and rule out basal cell carcinoma.


Conclusion: The descriptive terminology of potential cutaneous malignancies utilized by nondermatologists may provide important clues to aid dermatologists in triage decisions. Specifically, ulcerated, nonhealing, and rule out basal cell carcinoma may be terms that indicate the patient should be seen by the dermatologist in a timely manner.

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