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  Issue 2 (2001)

Dermopharmacy News
Computer-aided Tele- and Dermatoscopy

High Level of Safety in Diagnosis of melanocyte Skin Changes

The increase in melanoma diseases has entailed a series of educational work which has reached the public to a great extent by reports in the media. Dr. med. Winfried Klövekorn, Gilching reported within the scope of a professional advanced training in Regensburg in November 2000 that as a consequence only in his dermatological practice 17000 patients have consulted him for a control of their naevi in the last five years. One third of the patients examined, showed dysplastic naevi and at 292 (1,6 percent) a melanoma had been diagnosed. In order to back up the diagnosis, the digital top-light microscopy - an innovative procedure - had been applied which is also interesting from an economic point of view for the dermatologic practice.

In view of the increase of patients and the necessity of safe diagnostical methods, the optical company Rodenstock has successfully searched for more efficient possibilities of diagnosis and documentation techniques in cooperation with the university of Regensburg and the Institut für Informatik der Technischen Universität Munich (Institute for Informatics at the Technical University). They consist on the one hand in a standardization of the photograph techniques by incorporating the top-light microscopy and on the other hand in an improvement of the evaluation possibility and comparability of results. The combination of digital storing of the findings and a internal consultation or via tele-medicine are advantages in this context which have led to a rise of diagnostic safety by 20 to approximately 90 percent.

High-technology diagnostics
Mark of quality

As Klövekorn pointed out, the dermatological practice profits from an integration of the computerized video documentation and tele-dermatoscopy as support of the diagnosis, particularly since the diagnostic look solely does not impress the well-informed patient of today any more. The self-evidence of the application of modern techniques does not stop at physicians' practices. As achievement of outer space, the photograph system by Rodenstock has been published by the expert press last year and has impressed the public. Besides the undoubtedly convincing diagnostic method of early diagnosis of melanomae, according to Klövekorn, the high-technology diagnosis contributes to a higher acceptance, satisfaction, confidence and compliance of patients. "In view of the growing significance of private liquidation, the patient becomes a customer expecting an innovative equipment in the practice for a performance to be payed by himself". As clear gain for the quality, the dermatologist sees moreover the possibility of a proper archiving, recording the moment, the extent and the localization of the skin change. Manual sketches, stamp patterns and the preparing of overheads belong to the past because they are at the same time inaccurate and uneconomical. Besides an easy, rapid and low-cost reproducibility and comparability of findings, the validity can be ensured by cooperations with university clinics. The transmission of data allows consiliae by avoiding long distances and safes the patients' time. Klövekorn mentioned as positive example the cooperation of his practice with professor Dr. med. Wilhelm Stolz of the Universitätsklinikum (University Clinical Center) in Regensburg.

Prognostic Statements possible

The special technique of the digital top-light microscopy and the software-controlled dispersion of digitally stored images according to different criteria allows prognostic statements about the dignity of a skin change. Data bases will provide even better empirical results in the near future. Improved indication depth will render an excision in many cases unneccessary. Especially concerning cosmetically problematic skin regions as the face and the decolleté being inclined to keloid formation, this is an argument which cannot be disregarded.

Dr. med. Winfried Klövekorn

Economically interesting Investment

Services which can be offered beyond the EBM on the basis of private liquidation are an existantial pillar for many practices. They are possible for services not listed in the EBM catalogue as well as for IGEL services. Considering the economic aspect of the liquidation according to GOÄ-paragraph 612a (see box) the computer-aided tele and dermatoscopy of the melanoma diagnostics is an important sales factor for the dermatologic practice. In view of the high and steadily increasing incidence of the melanoma of at present 7:100.000 and the frequent examinations at legally ensured leaving out of consideration from the EBM of the GKV, a diagnostically useful and economically interesting service can thus be offered. The rising demand for such examinations will in all likelihood lead at correspondingly equipped practices to a patient-selection and -relationship. The introduction of the method does not require additional personnel, ensures the easy and cost-saving archivation of findings and furthermore a short amortization time can be expected.(ghw)

The computer-aided tele- and dermatoscopy for the melanoma diagnostis corresponds to 757 points and can be charged according to GOÄ paragraph 612a with DM 198,48. The settlement has been layed down in a commentary to the GOÄ (3rd edition, 5th supplement as of 1 February 2000): "for a video documentation of skin changes justified by medical grounds, in particular for the purpose of controlling of the evolution of naevi, no. 612 (whole-body plethymography) can be analogously charged on the basis of a corresponding decision of the GOÄ committee of the BÄK from 29 September 1998. The calculation is restricted to once per therapeutic session independently from the number of documented skin findings.


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