BT25 Successfully utilizing a novel teledermatology pathway in a suspected skin cancer clinic: improving patient experience and reducing time from referral to assessment

Abstract In the UK the incidence of skin cancer has increased by 26.1% since 2013, with 225 000 cases diagnosed in 2019. In response to the rising demand we must adapt our service pathways to ensure patients have a reliable, responsive service that meets the National Health Service Faster Diagnosis Standard. Prior to adapting our service, we had 600–900 referrals per month, with an increasing backlog of patients who were waiting to be seen, missing the 14-day target. For several years, an effective collaborative partnership with our plastic surgery colleagues has greatly improved our skin cancer service; patients were seen face to face, with dermatology and plastic surgery consultants working side by side in a polyclinic format. Despite this, the pressure on services still resulted in a backlog, with only 0.7% of referrals seen within 14 days in July 2023. In July, we introduced a teledermatology service to run in tandem to our face-to-face service; this allowed for increased capacity and also improved our referral response times. There are several exclusion criteria for our new pathway. If a general practitioner refers a lesion with a high level of concern for malignancy, if the patient is over 85 years old, or if there are multiple lesions, patients are assessed face to face; the remainder are reviewed via teledermatology. Within 7 days of referral, the patient is assessed face to face by an experienced dermatology healthcare assistant. They complete a skin cancer assessment and take macro and dermoscopic images of the lesion. This information is uploaded onto our electronic medical record and reviewed by a consultant within 5 days. If the lesion is concerning for malignancy or the diagnosis is unclear, patients are booked for face-to-face review within 14 days. The patient can also be directly listed for surgery; for those directly listed, they are sent a letter with our minor surgery patient leaflet and offered a face-to-face appointment prior to their procedure only if they desire. For benign lesions, the patient is discharged directly following teledermatology review. Our system has been designed to be flexible; if it is felt there are other lesions of concern by the healthcare authority, or if there is insufficient information or subquality images, the patient can be easily and quickly transferred to a face-to-face review. Within 6 months, we are now seeing over 95% of our referrals within 14 days. Our data demonstrate that by adapting our service and introducing a teledermatology pathway, we have significantly improved time from referral to assessment and improved the experience for patients. We aim to continually improve and adapt the service, adjusting it as needed with service demand.