Introduction The increasing use of teledermatoscopy in clinical practice has led to demands to evaluate the effects of this new technology on traditional healthcare systems. Objectives To study lead times from first consultation in primary care to diagnostic excision of suspected malignant melanoma lesions in traditional referrals to a tertiary hospital-based dermatology clinic compared with mobile teledermatoscopy referrals. Methods A retrospective cohort study design was used. Data on sex, age, pathology report, names of caregivers, clinical diagnosis, date for first visit to primary care unit, and date for diagnostic excision were collected from medical records. Patients managed through traditional referral (n=53) were compared with patients managed at primary care units using teledermatoscopy (n=128) regarding lead time from first visit to diagnostic excision. Results Mean time from date of first visit at primary care unit to diagnostic excision did not differ between the traditional referral and teledermatoscopy groups (16.2 vs. 15.7 days, median 10 vs. 13 days, p=0.657). Lead times from date of referral to diagnostic excision did not significantly differ (15.7 vs. 12.8 days, median 10 vs. 9 days, p=0.464). Conclusions Our study indicates that lead time to diagnostic excision for patients with suspected malignant melanoma managed by teledermatoscopy was comparable and not inferior to that of the traditional referral pathway. If teledermatoscopy is used at first consultation in primary care, it could potentially be more efficient than traditional referral.
BACKGROUND Teledermatoscopy (TDS) has successfully been incorporated into the healthcare system of Stockholm Region, serving a population of 2.4 million with nearly 240 Primary care units. The full implementation was preceded by a pilot project conducted in 2015-2021. The implementation has been complex as it involves several levels of care, several contractual structures, procurement of a technical solution integrated into the regional IT environment and a major training mission. Political initiatives played a critical role in making the system a reimbursed utility for healthcare providers. Approximately 1.500 referrals for suspected skin lesions are now sent monthly to Karolinska Hospital's dermatology unit for assessment. We expect a steady increase in the number of referrals as the implementation is still being completed in several primary care centers and as TDS is recommended in the Swedish melanoma guidelines. OBJECTIVE The aim of this analysis was to investigate the following aspects: the rate of excision recommendations, the detection of melanoma and other types of skin cancer, the proportion of lesions requiring no further action other than reassurance. Additionally, a study on lead times to excision was conducted 2016 to 2019 during the pilot project time to ensure the safety and effectiveness of utilizing TDS. METHODS A comprehensive review was conducted on the TDS platform by collecting pathology reports and linking them to tagged dermatoscopic diagnoses. To examine lead times to excision for urgent melanoma referrals, a comparison was made between TDS and traditional electronic referrals to a tertiary hospital. RESULTS Between June 1, 2021, and May 27, 2023, a total of 13,923 consultations were conducted. Excision recommendations were made for 18 percent of these consultations, resulting in the detection of 262 melanomas and several other malignancies. Furthermore, over 80 percent of patients received reassuring messages, eliminating the need for unnecessary surgeries or referrals to secondary care doctors. In the lead time study, 128 patients referred by TDS that met the criteria of double reader consensus for melanoma suspicion were compared with 53 patients referred for melanoma suspicion to a tertiary hospital (Södersjukhuset, Stockholm, Sweden) by traditionally electronic referral. Patients from primary care with suspected melanoma, regardless of the referral route, experienced a median lead time of 12 days (interquartile range [IQR] 6-19; mean 15.8) from their initial consultation to diagnostic excision. Notably, those who underwent TDS during their first visit and had excision performed in primary care achieved significantly faster lead times. The median lead time for patients who underwent surgery at a primary care unit (n=40) was significantly shorter (p=0.013) compared to those who had surgery at other facilities (n=87), with lead times of 7.5 days (IQR 3–19.5, mean 13.2) and 13 days (IQR 8–19, mean 15.2), respectively. CONCLUSIONS Teledermatoscopy enables dermatologists to diagnose skin malignancies at the patient's first visit to primary care, improving patient care by increasing diagnostic accuracy, reducing time to diagnostic surgery, and reducing unnecessary surgical procedures.
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