BT39 Teledermatology assessment of community skin lesion referrals: insights, challenges and recommendations

Abstract Consultations for skin lesions rank are a very common reason for general practitioner (GP) visits, with the urgent suspicion of cancer (USOC) referral pathway directing potentially cancerous lesions to dermatologists in our region. Despite the valuable role of clinical photographs alongside referrals, the variable quality poses a significant challenge. From March to April 2023, 100 GP referrals containing photos in our USOC pathway underwent analysis by two independent consultant dermatologists. They provided their top three diagnoses with free-text comments on image quality. Notably, prevalent image comments included ‘out of focus (60%)’ and ‘poor illumination’ (55%). Dermoscopy images were included in 15 community photos. Consultant 1 (G.G.) identified seborrhoeic keratosis as the primary diagnosis in 32%, while consultant 2 (R.J.) noted it as the top diagnosis in 34%. Consultant 1 included the GP’s diagnosis in their top three differentials 40% of the time, while consultant 2 did so 30% of the time. Existing guidance on teledermatology image quality is limited but emphasizes clear, well-lit photos with proper focus, taken from various angles and distances. Despite this, our data reveal a noticeable deviation from these practices. We propose that possible contributory factors leading to poor-quality images include time constraints during GP consultations, lack of awareness regarding guidance, and the use of devices with suboptimal image resolution. Notably, there are no local specific guidelines for community photos in our area. Based on our findings, we have created a local guideline, emphasizing the need for clear, focused images where the lesion is centrally framed, utilizing natural sunlight ideally at an angle to highlight skin texture. Additionally, an enlarged photo is recommended, balancing size with the maintenance of focus on the area of interest. Teledermatology provides broader access to expert advice, facilitates timely consultations, improves efficiency, and encourages global collaboration. However, the heterogeneity in photos can lead to misdiagnosis, inappropriate triage, and inefficient resource allocation. The implementation of guidance for referral photos can optimize resource use, enhance patient satisfaction, and streamline workflow.