BT08 Outcomes of urgent suspected cancer, urgent and routine skin lesion referrals assessed via teledermoscopy service

Abstract This retrospective study examines the outcomes of referrals from primary care to our skin lesion service following the assessment of high-resolution clinical and dermoscopic images taken by medical photographers. The study investigates the prevalent diagnoses and outcomes of referrals in relation to the referral pathways, namely urgent suspected cancer (USC) vs. urgent vs. routine referrals. Referral letters along with clinical and dermoscopic images of 1203 patients referred between September 2022 and December 2023 were reviewed by a consultant dermatologist with an interest in dermoscopy and skin cancers. The urgency of referrals, clinical diagnoses and management plans were recorded in a spreadsheet for data collection. Most of the referrals (44.9%) were sent as USC. The others were referred as urgent (23.1%) and routine (32%). The most common diagnosis in all the groups was seborrhoeic keratosis, followed by basal cell carcinoma (Table). Surprisingly, there was no significant difference in the occurrences of these conditions between the three groups. Of all the USC referrals, 41.8% were discharged, 23% were directly booked for minor operative procedures (MOPs) and 24.4% required face-to-face (FTF) assessment for review or diagnostic biopsies. In the urgent group, 46.2% were discharged, 21.9% were booked for MOP, and 23.7% were invited for FTF assessment. Among the routine referrals, 59.1% were discharged, 19.3% were booked for MOP, and 17% were advised FTF assessment. In all the groups, 2–3% of the referrals were directly forwarded to other specialties (plastic, maxillofacial or oculoplastic surgery). Digital monitoring (by arranging for repeated photographs 3 months later for comparison) was requested for 8% of USC, 5.7% of urgent, and 1.8% of routine cases. Most of the digital monitoring cases (35.7%) were for melanocytic lesions, whereas the others were for suspected lichenoid keratoses and irritated seborrhoeic keratoses. Seborrhoeic keratosis was diagnosed in over one-quarter of all pathways of skin lesion referrals. In total, 84% of cases referred as USC were either benign or nonurgent, whereas 5% of routine referrals were suspected to be melanomas or squamous cell carcinomas (SCCs). This highlights the urgent need for improved diagnostic skills when recognizing common skin lesions in primary care. High-resolution clinical and dermoscopic images in a teledermoscopy service provide a helpful tool to prioritize patients effectively and facilitate standardized digital monitoring in selected cases.DiagnosesUSC (n = 540, 44.9%)Urgent (n = 279, 23.1%)Routine (n = 384, 32%)Seborrhoeic keratosis25.9%27.6%25.8%Basal cell carcinoma15%18.6%19%Benign naevi14.4%9.3%8.8%Actinic keratosis5.4%7.2%9%Melanoma/SCC15.9%8.2%5%