BT32 Teledermatology service evaluation compared with standard face-to-face review for 2-week-wait skin cancer referrals

Abstract Teledermatology has been shown to be accurate in the diagnosis of skin cancer. The number of skin cancer referrals to secondary care has surged and dermatology departments are under increasing pressure to meet cancer pathway targets. The aim of this study was to compare service outcomes for teledermatology vs. conventional face-to-face review. We performed a retrospective review of adult patients referred by general practitioners for suspected skin cancer via the 2-week-wait pathway from August 2022 to February 2023. Patients were assessed either by conventional face-to-face appointment or via teledermatology. Teledermatology patients completed a questionnaire and were seen by a photographer in the community who took regional, macroscopic and dermoscopic images. The primary outcomes were times from referral to first clinical appointment and to surgery (if applicable), surgical intervention rate, and histological diagnoses (if applicable). Statistical analysis was performed using Prism software (GraphPad Software, La Jolla, CA, USA). Comparisons between groups were performed with the Mann–Whitney U-test and Fisher exact, as appropriate. P-values 0.05 were considered statistically significant. In total, 50 consecutive patients assessed by a single clinician via teledermatology were compared with 100 randomly selected patients assessed by the same clinician via face-to-face review. More than half of patients were female in both groups (52% teledermatology vs. 58% face-to-face). The teledermatology group was older ,with a mean age of 56.7 years (SD 18.5) vs. 40 years (SD 20.5), P 0.001. The median waiting time for a clinical appointment was slightly longer in the teledermatology group 16.5 days (SD 8.5) vs. 14 days (SD 5.4) for face to face (P 0.001). The median waiting time from receipt of referral to surgery was similar in both groups 38 days (SD 17.3) for teledermatology vs. 32 days (SD 12.5) for face to face (P = 0.4). The median waiting time from decision to treat to surgery was similar in both groups 21 days (SD 17.3) for teledermatology vs. 20 days (SD 11.7) for face to face (P = 0.9). There was no significant difference in the diagnostic biopsy/therapeutic excision rate (34% for teledermatology vs. 27% for face to face, P = 0.37), or in the proportion of benign, dysplastic and malignant lesions biopsied or excised (P = 0.75). Over one-third of patients reviewed by teledermatology were discharged without the need to attend hospital. In conclusion, this model of teledermatology offers a robust way to assess suspected cancer, with biopsy rates and eventual diagnoses comparable with conventional models. The use of professional medical photography may delay initial review, but higher-quality images are associated with improved diagnostic accuracy.