BT21 Teledermatology pathway performance for detection of all skin cancer categories

Abstract The aim of this study was to audit the performance of a UK nurse-led teledermatology pathway for private patients with skin lesions suspicious of melanoma, basal cell carcinoma (BCC) or squamous cell carcinoma (SCC). Patients with suspicious skin lesion symptoms (change in colour, shape or size; 7 mm; inflamed or oozing) access the teledermatology pathway without general practitioner referral and are initially seen in private, community clinics by specialist skin cancer nurses trained in lesion detection and dermoscopy. Following a detailed lesion history, digital and dermoscopic images are taken then uploaded to the electronic patient management system for telemedicine reporting by experienced teledermatology specialists. Following telemedicine review, patients are either reassured or advised to attend a consultation with a skin cancer specialist for face-to-face examination with or without biopsy on the same day. Between 1 January 2018 and 31 December 2022, a total of 14 790 patients (6089 male, 8701 female; mean age 42 years, range 18–92) entered the diagnostic pathway. In total, 83% were offered a nurse appointment within 5 working days and 94% within 10 working days. Following telemedicine triage, 12 070 (81.6%) were reassured, and the remaining 2720 (18.4%) were advised to attend a consultant appointment. Of these 2720 patients, 2525 accepted this appointment, with the remaining 195 (0.01% of the total) attending the National Health Service (NHS) or alternative private provider. Of the 2525 who attended for further examination, 1634 underwent biopsy (11.0%) and 550 were diagnosed with skin cancer (cancer detection rate of 3.7%). Of the 550 skin cancers detected, there were 88 melanomas, 439 BCCs, 22 SCCs and one cutaneous B-cell lymphoma. Stage at diagnosis was available for 81 melanomas, with 78 (96%) of these patients diagnosed at American Joint Committee on Cancer (version 8) stage 1 or 2. There were no missed cancers documented during (or since) the audit period, giving a sensitivity of 100%, a specificity of 87.7% and an overall accuracy of 86.5% for the teledermatology cancer pathway. This audit confirms that a community-based and nurse-led teledermatology service for patients with one or more suspicious skin lesions can provide short waiting times to lesion assessment and diagnosis, with 81.6% reassured following telemedicine triage and only 18.4% attending a hospital appointment for further assessment and possible biopsy. The cancer detection rate is lower than in the NHS, but commensurate with the younger demographic of private patients. The early-stage melanoma diagnosis rate of 96% is well above the equivalent rates reported by NHS Digital for men (85%) and women (89%) in 2020. All authors are employed by the pathway provider.