BT09 Cutting out the clinic: evaluating a teledermatology-led tertiary urgent skin cancer service with a ‘direct-to-surgery’ pathway

Abstract

Urgent skin cancer referrals to secondary care are continually increasing. In total, 15 048 patients were managed at our centre in 2025, placing pressure on outpatient capacity and timely access to treatment. We run a consultant-led teledermatology virtual clinic, offering rapid triage and streamlining through a ‘direct-to-surgery’ (DTS) pathway. However, whether a DTS pathway confers a meaningful clinical advantage over face-to-face review was previously unclear. The aim of this study was to evaluate the efficiency of a consultant-led teledermatology virtual clinic and DTS pathway within an urgent skin cancer service. We undertook a retrospective review of urgent skin cancer referrals between 3 February 2025 and 17 February 2025, analysing referral characteristics, triage outcomes, time to intervention and histology. In total, 544 patients were included (40% male, 60% female; mean age 64 years). The general practitioners’ suspected diagnoses were squamous cell carcinoma (n = 258), melanoma (n = 235), high-risk basal cell carcinoma (n = 36), ‘benign’ (n = 2) or no diagnosis (n = 13). Clinical impression at virtual clinic triage was documented in 421, with suspected malignant or premalignant lesions in 36.7%. Overall, 124 patients had no documented impression at the virtual clinic due to suboptimal image quality or diagnostic uncertainty. Following triage, 198 patients (36.3%) were discharged, 124 (22.8%) were triaged to DTS and 134 (24.6%) underwent face-to-face review. In total, 181 patients were referred for surgery. DTS achieved shorter times to intervention than face to face (mean triage-to-biopsy time 31 vs. 45 days, triage-to-excision time 44 vs. 52 days). Forty patients were triaged straight to plastic surgery; patients who underwent procedures under plastic surgery (n = 29) had a mean triage-to-procedure time of 67 days. Histology confirmed 77 benign lesions, 42 basal cell carcinoma, 35 melanocytoma and dysplastic naevi, 17 squamous cell carcinoma, 15 Bowen disease and 8 melanoma (including in situ). The teledermatology virtual clinic discharges over one-third of patients without requiring face-to-face review. The DTS pathway enables faster intervention and preserves clinic capacity for complex cases, aligning with ‘Getting It Right First Time’ principles. However, the economic impact of teledermatology-based pathways is yet to be formally evaluated.