Outcomes of Urgent Suspected Cancer, Urgent, and Routine Skin Lesion Referrals Assessed via Teledermoscopy Service: A
1Dermatology, Aneurin Bevan University Health Board, Newport, GBR.
Background:
Teledermoscopy facilitates the remote assessment of skin lesions by combining high-quality clinical and dermoscopic images. This technology enhances early detection of skin cancers by allowing specialists to evaluate lesions without the need for an in-person consultation. Beyond improving diagnostic accuracy, teledermoscopy supports efficient triage, prioritising patients who require urgent attention while reducing unnecessary clinic visits. Additionally, it enables longitudinal digital monitoring of lesions, allowing clinicians to track subtle changes over time, improve patient follow-up, and guide timely interventions.
Aim:
To evaluate diagnostic outcomes and management decisions from primary care skin lesion referrals assessed via teledermoscopy across urgent suspected cancer (USC), urgent, and routine pathways.
Methods:
A retrospective review was conducted of 1,203 patients referred to the South East Wales teledermoscopy service between September 2022 and December 2023. Referral letters and images were assessed, and cases were categorised by referral urgency. Final diagnoses and management outcomes were recorded, including discharge, minor operative procedures (MOPs), face-to-face (FTF) reviews, onward referrals, digital monitoring, or patient-initiated follow-up (PIFU).
Results:
Nearly half of referrals were USC, with the remainder split between urgent and routine pathways. Seborrhoeic keratosis was the most frequent diagnosis, accounting for over a quarter of cases, while basal cell carcinoma was the most common malignancy identified. Probable melanomas and squamous cell carcinomas were concentrated in the USC pathway, but were also detected in urgent and routine referrals. Management outcomes varied: most routine cases were discharged, while a greater proportion of USC referrals required MOPs or FTF review. Digital monitoring was applied selectively and often led to safe discharge or escalation to FTF review. Histological confirmation of melanoma or SCC occurred in a small but essential proportion across all pathways.
Conclusion:
Teledermoscopy safely reduced unnecessary FTF consultations and efficiently identified high-risk lesions. Most USC referrals were ultimately benign, highlighting the need to strengthen diagnostic confidence in primary care.
