P207 Evaluation of more than 6000 referrals to dermatology for urgent suspected cancer managed by digitized store-and-forward teledermatology as an alternative to face-to-face assessment

Abstract

A retrospective overall service evaluation was undertaken of consecutive urgent suspected cancer (USC) referrals managed via store-and-forward teledermatology. Data were retrieved for a single centre where a digital platform is used to record focused clinical histories using a standardized pro forma and capture macroscopic and dermoscopic images of the lesion(s). The imaging protocol is compliant with BAD recommendations. Consultant dermatologists then remotely review and determine the clinical diagnosis and management within 72 h. Outcomes measured included discharge, biopsy/excision rate, urgent face-to-face (FTF) or routine clinic review and cost. Additionally, a subset of consecutive referrals from April 2025 was further analysed for general practitioner referral diagnosis vs. dermatologist diagnosis, triage outcome and, where biopsies were performed, histopathological concordance. Of 6653 USC referrals, 51.3% had a biopsy/excision, 32.9% were discharged, 14.7% had a routine review and only 0.9% had an urgent FTF review for the same lesion(s). Dermatologists could assess 40 cases per planned activity for half the cost of the FTF clinic. Subset analysis of 406 cases showed referral diagnosis of melanoma (36%) and squamous cell carcinoma (SCC) (34%), and 29% with no diagnosis offered. Dermatologist clinical diagnosis included 4% melanomas – no melanomas were missed, and there was 100% sensitivity for melanoma detection. SCC was suspected in 8% and basal cell carcinoma in 9%, with 92% histological concordance. The overall conversion rate for reportable cancer was 5.6%. The most frequent benign diagnoses were seborrhoeic keratoses (25%), benign naevi (18%) and actinic keratosis/Bowen disease (5%). From the biopsied lesions, the histology results showed that 23% were melanoma, SCC or basal cell carcinoma; 6% were precancerous and 72% were benign lesions. As far as we are aware, this is the largest study of store-and-forward teledermatology for skin lesions referred on a USC pathway. It demonstrates that a well-designed teledermatology service represents a sustainable model for this increasing workload.