Improving melanoma diagnosis in primary care--a tele-dermatoscopy project

TeleDerm is a web-based service designed to provide general practitioners (GPs) with rapid assessment of dermatoscopic images of pigmented lesions and moles. During a 12-month period, GPs at the Hastings and Rother primary care trust referred a total of 660 lesion images from patients exhibiting less typical symptoms of cancer, who would otherwise have been routinely referred to hospital. The images were assessed by remote expert dermatologists. Of that total, 493 images (75%) were reported as displaying no suspect dermatoscopic structures, resulting in the GP discharging the patient. In addition, seven lesions (1%) were reported as displaying suspect dermatoscopic structures, resulting in the GP urgently referring the patient to hospital with a subsequent histological confirmation of melanoma. The overall costs per patient were reduced by 50%. In an independent survey, all 11 patients rated their experience as good to excellent. The results show that tele-dermatoscopy can provide GPs with an expert second opinion to increase the quality of diagnosis in primary care, reduce the costs of dermatology provision and provide a highly rated patient experience.