E‐referrals and teledermatoscopy grading for melanoma: a successful model of care

Abstract

Background/Objectives: An e-referral system was developed at a tertiary care hospital in Auckland, New Zealand in 2014 for suspected cutaneous malignancy. E-referrals include patient information, a description of the lesion(s), biopsy results and/or attached photograph(s). Experienced surgical oncologists prioritised the referrals and selected a management option or referred them for a teledermatoscopy opinion. Our aim was to review the efficacy of e-referrals for improving diagnostic accuracy for melanoma. Methods: Referrals received in 2016 includingimages and categorisation as confirmed, likely or suspected melanoma by the triage specialist were evaluated. Concordance of the pathological diagnosis with the triage diagnosis and teledermatoscopy diagnosis was determined for each referral.Results: 809 of 3470 e-referrals for skin cancer were categorised as confirmed, likely or suspected melanoma. 230 (28.4%) of these included a referral histopathology confirming melanoma/melanoma in situ. Of the remaining 579 referrals, 315 were sent for urgent diagnostic excision and 264 were referred for teledermatoscopy. 120 of the 315 sent for urgent excision were confirmed as melanoma (53) or melanoma in situ (67) on histopathology: a positive predictive value (PPV) of 38.1% and number needed to excise (NNE) of 2.6. Less than 10% of referrals triaged for teledermatoscopy were confirmed as melanoma (24/264). Almost half of all referrals (374/ 809, 45.6%) included melanoma/melanoma in situ. The melanoma: melanoma in situ ratio was 1: 1.18. Conclusions:The e-referral and teledermatoscopy service for suspected melanoma has proven fewer unnecessary excisions of benign lesions than previously reported.

Remote Skin Cancer Diagnosis: Adding Images to Electronic Referrals Is More Efficient Than Wait-Listing for a Nurse-Led Imaging Clinic

“…By mid-2019, the publicly funded VLC had evaluated more than 11,000 lesions in 6600 patients attending scheduled nurse-specialist clinics in three community locations [ 13 ]. The safety and efficacy of the VLC model has been confirmed [ 14 , 15 ].…”

Lead Time From First Suspicion Of Malignant Melanoma In Primary Care To Diagnostic Excision: A Cohort Study Comparing Teledermatoscopy And Traditional Referral To A Dermatology Clinic At A Tertiary Hospital

“…Median time to excision of a suspected melanoma was 40 days from VLC assessment. In another consecutive study from New Zealand, Sunderland et al showed that a hybrid e-referral system, where an experienced surgical oncologist selected the management option or referred suspected melanomas for TDS, could reduce the number requiring excision [ 30 ]. In a TDS project in Belgium (Telespot), Damsin et al found a median delay of 11 days between TDS diagnosis and treatment of high-priority lesions, which was seven times shorter than the conventional care pathway [ 17 ].…”

The role of mobile teledermoscopy in skin cancer triage and management during the COVID-19 pandemic

“…More recent studies citing some of the patient-reported advantages of direct-to-consumer mobile teledermoscopy include convenience, the option to avoid an in-person visit, and having a record of skin lesions to reference. 39 Other studies even highlight that incorporation of mobile teledermoscopy increased patients' motivation in performing regular self-skin exams. 20 Teledermoscopy is limited by the quality of images that can be captured by the consumer with limited expertise .…”