Here in the Hospital de Câncer de Barretos, Megh and I are working in the Prevenção / Prevention Department, where they most commonly check for breast, cervical, and skin cancer. In particular, we have been mainly working with Dr. Carlos, as part of the skin cancer prevention team. This week he showed us a bit of what he does and what he has worked on here.
One of the main goals for the Prevention Department is undoubtedly the diagnosis of cancerous skin lesions. Dr. Carlos explained that the hospital has several methods of doing this:
A complete skin biopsy involves excising a portion or the entire skin lesion itself and analyzing it in their pathological lab in order to check for cancerous cells. This is the golden standard of diagnosis, but also the most resource-intensive.
A face-to-face dermatoscope examination involves a personal appointment with the patient in which the skin lesion is closely examined with a specialized optical tool called a dermatoscope. This is the most common method, as it is both effective and efficient. However, the dermatoscopes still present a signficant cost and it also requires the patient to be present at the hospital.
An online method called teledermatology, in which skin cancer diagnoses are communicated via email. Nurses in towns and villages without proper hospitals capture images of the skin lesions and Dr. Carlos is able to reply with the appropriate plan of action for the patient. This method was part of Dr. Carlos’s research, and he has been working hard to develop this program. Even though it has proven effective and efficient, there are still several issues with it — and this is why we are here!
This week, we sat down with Carlos and he carried out live teledermatology diagnoses with us for us to better understand his process.
1. It all starts with the training of the nurses — they come for a three-day training and are taught how to distinguish potentially cancerous lesions from other skin abnormalities. They are then equipped with smartphones and given instructions regarding the format of the emails and how to best take the images. Dr. Carlos also showed us the slideshow he presents at the training, and we were able to learn a little bit ourselves about the ABCD of skin lesions!
2. Nurses takes images of patients and send them to Dr. Carlos. The nurses take their smartphones and hold appointments at their respective town or village, where they try to identify cancerous lesions for diagnosis. They package the images, and send them to Dr. Carlos with the subject line: Name of patient + city. This is important for Dr. Carlos, as he organizes all of his emails under tabs for each city and it is how he is able to track patients.
3. Dr. Carlos analyzes the images and makes a diagnosis. He has three pre-written replies that he can paste in each email. If he suspects cancer, he can either tell them to be present at the next visit from the HCB Mobile Unit, or he can set up an appointment to come to Barretos. If he sets up an appointment in Barretos, he has to wait for the nurse to send more detailed patient information before he can enter the patient in their Sis-Onco database system for the secretary in Barretos to schedule the time and day for the appointment. If he does not suspect cancer, or know what it is, he simply answers: “I’m not a dermatologist, you should have this checked by a dermatologist in your area.”
4. The patients come in to have their lesions removed. The patients with suspected lesions are asked to come and depending on the nature of the lesions, they are sent to one of two places: plastic surgery department for larger and more complicated lesions, or to doctors like Dr. Carlos in the Prevention department. One important thing to note that Dr. Carlos mentioned — unlike other hospitals that might be more interested in tracking the development of lesions in order to see if they are cancerous or not, HCB prefers to just eliminate the possibility of skin cancer. Their volume of patients is so high that they simply cannot track the patients, and as most of them come from cities farther away, it is safer to just remove the lesion. And, as Megh mentioned in her blog post, we were able to watch the skin lesion surgeries themselves!
In an upcoming blog post, I will explain more about our device + application Melacap, and how we are trying to improve this teledermatology system to be able to prevent even more cases of skin cancer here in Brazil.
Até a próxima!