P218 Improving efficiency in dermatology: the role of teledermatology in urgent suspected cancer referrals

Abstract

Dermatology services in the NHS face increasing pressure from rising urgent suspected cancer (USC) skin referrals, which can delay timely specialist assessment. Teledermatology has emerged as a triage tool to streamline pathways by enabling rapid remote review of clinical and dermoscopic images, potentially reducing unnecessary face-to-face (F2F) appointments. This quality improvement project evaluated the impact of introducing teledermatology on F2F appointment rates, procedure conversion and diagnostic accuracy within a USC pathway. We compared 2 months of referrals before and after the implementation of teledermatology. All suitable patients attended a community photography hub where macroscopic and dermoscopic photos were taken. The photographs were then reviewed by a consultant dermatologist within 72 h. Outcomes measured included the proportion of referrals requiring F2F review, the conversion rate of F2F assessments leading to biopsy or surgical intervention, and agreement between clinical and pathological diagnoses. Before teledermatology, 385 referrals resulted in 385 F2F appointments (100%). After implementation, 258 referrals generated only 77 F2F appointments (30%), representing a 70% relative reduction. Among patients seen in person, procedure conversion remained stable (14% before vs. 13% after). This was contrary to expectations of an increased conversion rate following triage, as teledermatology was used solely to prioritize F2F review rather than direct patients to biopsy or surgery. Diagnostic accuracy was maintained, with clinical–pathological agreement improving from 77% before teledermatology to 88% after. Teledermatology significantly improved service efficiency by reducing unnecessary clinic attendance while safely prioritizing high-risk lesions. Stable procedure conversion rates and preserved diagnostic accuracy suggest that remote triage did not compromise care quality. A key limitation was that some benign lesions, particularly seborrhoeic keratoses, still required F2F assessment due to the limitations of image-based evaluation in confidently excluding malignancy. Overall, teledermatology demonstrated a substantial positive impact within the USC pathway, reducing face-to-face appointments while maintaining safety and diagnostic reliability.