Inpatient Dermatology Consultations for Suspected Skin Cancer: A Retrospective Review
Practice Points
- Dermatologists who perform inpatient consultations should be prepared to be consulted for cutaneous malignancies.
- Relatively large skin tumors may be identified, often incidentally, in the inpatient population.
- Careful consideration should be involved when deciding how to diagnose and manage cutaneous malignancies identified in the inpatient setting, taking the overall medical and social context into account.
In summary, approximately half of the inpatient dermatology consultations for suspected cutaneous malignancy resulted in a diagnosis of skin cancer. The patients in this population were admitted for a range of diagnoses, most unrelated to their cutaneous malignancy, suggesting that the inpatient setting offers the opportunity for physicians in a variety of specialties to help identify skin cancer that might otherwise be unaddressed and then facilitate management, whether ultimately in an inpatient or outpatient setting.
In many of these cases, it might be most appropriate to arrange subsequent outpatient dermatology follow-up after hospitalization, rather than making an inpatient consultation, as these situations usually are nonurgent and not directly related to hospitalization. However, in cases in which the lesion is directly related to admission, the lesion is advanced, there is concern for metastatic disease, or extenuating circumstances make outpatient follow-up difficult, inpatient dermatology consultation may be reasonable. There sometimes can be compelling reasons to expedite diagnosis and treatment as an inpatient.
In hospitalized, medically complex patients, in whom a new cutaneous malignancy is identified, dermatologists should discuss the situation thoughtfully with the patient, the patient’s family (when appropriate), and other physicians on the treatment team to determine the most appropriate course of action. In some cases, the most appropriate course might be to delay biopsy or treatment until the outpatient setting or to even defer further action completely when the prognosis is very limited. Consulting dermatologists must be mindful of patients’ overall medical situation in planning care for a cutaneous malignancy in these inpatient situations.
This study also highlights the surprising number of large-diameter, high-risk tumors identified in these scenarios. Limitations of this study include a relatively small sample size from a single facility that might not be representative of other practice settings and locations. Future multicenter studies could further explore the impact of inpatient dermatologic consultation on the diagnosis and management of skin cancer.
