DERMAI AB

The skin is the tissue most commonly affected by cancer and the incidence of skin  cancer in Sweden is higher than for all other cancer types combined. This is rarely seen  in Swedish cancer statistics, because basal cell cancer is usually omitted. This of course  places high demands on dermatological competence to assess suspect skin tumors, as well as to handle large patient volumes in a patient-safe manner. In many other  countries with significant numbers of inhabitants being sensitive to sunlight, such as the  United States and Australia, the incidence of skin cancer is high and, year-by-year,  ascending. Malignant melanoma in the skin has increased in Sweden since the 1960s and, despite having a lower incidence than other skin cancers, is the most lethal form of skin cancer.  In this respect, it is the only, of all, cancers in Sweden for which the number of deaths  has continued to increase (in recent years by over 500 per year). Malignant melanoma develops from our pigment-bearing cells, the melanocytes, which  in addition to the skin are in the eyes and mucous membranes (in fewer numbers). Early  detection is crucial for the prognosis, as melanoma grows thicker over time, and the thickness has a direct correlation to metastasis and risk of death. Since even the trained physician can not to 100% determine what skin lesion is malignant or not, an excess of excisions of suspected lesions is still needed. The  specimen is then sent for pathological examination in the microscope for verification if  it is benign or malignant. Dermatologists have shown to be superior to General  practitioners (GPs) in their ability to detect melanoma early. Dermatologists can also safely determine, with the help of patient history, inspection and dermoscopy, whether it is safe for the patient to avoid unnecessary biopsy or excision. For Swedish health care conditions, it has been shown that overall healthcare costs can be reduced if patients are assessed by dermatologists as their primary contact, compared to GPs. This is partly due to the fact that patients starting in primary care are often later referred to the dermatologist, adding an unnecessary time delay. But the majority of savings are due to less uncalled-for surgery. At the same time, literature shows that the clinical diagnosis of cutaneous melanoma even by a trained dermatologist, has shortcomings in both specificity and sensitivity. In  particular, complementary anamnesis, status and dermoscopy have been demanded to  further reduce the number of excisions while maintaining the same level of patient safety. Excisions are costly but also create unnecessary anxiety while awaiting the report from the pathologist. Furthermore, the number of outpatient dermatologists and pathologists is too small to cover the demand in Sweden.