TELEDERMATOLOGY READER REPORT1
HISTORY
Chief Complaint
Presenting for diagnosis of lesions on the shoulder.
History of Present Illness
A 52-year-old male presents with two side-by-side lesions on his left shoulder that bother him in color, texture, and size. Prior treatment: none. His primary symptoms: none. Prior biopsy: none. He has a personal history of melanoma. Other significant laboratory/study findings: none.
IMAGE QUALITY ASSESSMENT
Satisfactory with suggestions for improvement. Five in focus images for each lesion is preferred, with at least one lesion being macroscopic.
TELEDERMATOLOGY IMAGING READER REPORT1
Two images (one for each of the two lesions) were provided. The first image (Lesion A) shows a tan-colored, raised papule (see Figure 1). The second image (Lesion B) shows a dark-colored macule with an irregular border (see Figure 2).
INTERPRETATION OF IMAGES
Lesion A
Findings
The presented lesion is difficult to assess at this magnification and angle. This lesion is most consistent with a nonneoplastic nevus (see Figure 1).
Lesion B
Findings
The presented lesion is difficult to assess at this magnification and angle. This lesion is concerning for a dysplastic melanocytic lesion (see Figure 2).
The lesions are clearly marked, and the approximating lesion that is not in question is purposely obscured with a taped X for depiction accuracy.
RECOMMENDATIONS
Skin Care and Treatment Recommendations
Because of the patient's history of melanoma, Lesion B needs to be evaluated face-to-face with a dermatology provider for potential biopsy.
The patient should also be advised to utilize broad-spectrum sunscreens and sun protective clothing to avoid prolonged exposure to sunlight between the hours of 10 A.M. and 4 P.M. and have regular skin checks with dermatologist.
RECOMMENDED FOLLOW-UP
Type of Visit
Return for a face-to-face visit for evaluation and potential biopsy as deemed necessary with the dermatology nurse practitioner or dermatologist.
CLINICAL PEARL
The pearl in this case is the nursing skill in marking the lesions and assuring greater accuracy on the part of the telereading provider. The lesions are identified with marked circles, and the approximating lesion is purposefully obscured with a tape bearing X. This technique is useful when two lesions are in close proximity to each other.
Nursing and telehealth technician skills for optimal imaging are vital to the success of teledermatology, a modality that has the great potential to revolutionize access to dermatology services (Eedy & Wootton, 2001).
REFERENCES