Outpatient Dermatology Consultation Impacts the Diagnosis and Management of Pediatric Oncology Patients: A Retrospective Study

Abstract

Purpose: There are limited data on the impact of dermatology involvement on the care of pediatric oncology patients. Prior studies of the epidemiology of skin conditions and the role of dermatologists in the care of pediatric patients were not specific to the pediatric oncology population. The objectives of this study were to determine the characteristics of outpatient dermatology visits and the resulting impact on diagnosis and management of pediatric oncology patients. Methods: The medical records of all patients with a Dana-Farber Cancer Institute medical record number and a dermatology clinic visit at Boston Children's Hospital from 2008 to 2015 were retrospectively reviewed for demographic and medical information. Change in diagnosis was defined as discordance between dermatology and oncology assessment of the skin condition. Change in management was defined as the addition, withdrawal, or change in dose of topical or systemic medication. Results: The most common dermatologic diagnoses in 516 patients were skin infections (21.3%) and nonmalignant skin eruptions (33.4%). A diagnosis of significant impact (ie, malignancy, adverse cutaneous drug reaction, graft-versus-host disease, varicella-zoster virus, or herpes simplex virus infection), was made at the dermatology clinic in 14.7% of visits. Consultation resulted in a change in diagnosis in 59.8% of patients, change in dermatologic management in 72.4% of patients, and change in management of noncutaneous issues in 12.4% of patients. Conclusions: Outpatient dermatology consultation can affect the care of pediatric oncology patients, including the diagnosis and treatment of skin conditions and management of nondermatologic issues.