JMIR Publications

ABSTRACT

Background:

The suspected skin cancer (SSC) electronic referral pathway was introduced in 2017. It requires general practitioners to add regional, close-up and dermoscopic images to a lesion-specific referral template for a teledermatologist to review and advise on management. The virtual lesion clinic (VLC) is a nurse-led clinic used since 2010 to obtain high-quality images for teledermoscopy assessment. A limitation of both services is the absence of full body examination.

Objective:

To evaluate the number of skin cancers missed during teledermatology assessment.

Methods:

This is a retrospective review of skin lesion referrals to dermatology. SSC referrals made in the latter half of 2020 were compared with referrals to the VLC during a similar time period in 2016.

Results:

The study included 481 patients with 548 lesions in the 2020 SSC cohort that were matched for age, sex and ethnicity to 400 patients with 682 lesions in the 2016 VLC cohort. Forty-one patients underwent subsequent specialist review in the SSC cohort compared to 91 in the VLC cohort. Twenty percent of the SSC cohort and 24% of the VLC cohort were found to have at least one additional lesion of concern. The majority of these were keratinocytic skin cancers; there were 2 and 0 additional melanomas or melanoma-in-situ respectively. The VLC nurses identified additional lesions for imaging in 78 out of 400 (20%) patients assessed in VLC. The teledermatologist determined[AO1] that 73% of these additional lesions were malignant. Ten of the 548 lesions (2%) in the SSC group were re-referred, none of which had a change in diagnosis. Sixteen out of 682 lesions (2%) in the VLC cohort were re-referred, six of which (1%) had a change in diagnosis.

Conclusions:

Patients diagnosed with skin cancer often have multiple lesions of concern. Single-lesion teledermoscopy diagnoses have high concordance with in-person evaluation and histology; however, we have shown that in-person examination may reveal other suspicious lesions. The importance of full body skin examination should be emphasized to the referrer.