Primary Care Skin Lesion Referrals Assessed via Teledermatology: A Retrospective Analysis.

Introduction Teledermatology has become a vital component of dermatologic care in the United Kingdom, particularly following the COVID-19 pandemic. It offers an efficient, remote alternative to face-to-face consultations by utilising high-quality clinical and dermoscopic images to assess and triage skin lesions. This study evaluates the effectiveness of teledermatology referrals through both urgent suspected cancer (USC) and routine pathways, focusing on diagnostic accuracy, referral appropriateness, and patient outcomes within the dermatology service. Methods Between January and March 2022, 383 teledermatology referrals for suspected skin malignancies were reviewed. Of these, 194 (50.7%) were USC referrals and 189 (49.3%) were routine referrals. All referrals were reviewed and triaged by a consultant dermatologist based on the history provided and available clinical images. Patients were subsequently scheduled for professional photography, including dermoscopy images. Diagnoses and management plans were made following consultant review, with outcomes including discharge, minor surgery, referral to other specialities, or in-person consultation. Results A total of 47 different dermatological diagnoses were identified. Among USC referrals, only 16% were confirmed as high-risk skin cancers, including squamous cell carcinoma (8.8%), malignant melanoma (5.7%), and lentigo maligna (1.5%). In contrast, 5.8% of routine referrals were later identified as high-risk lesions, with 2.7% confirmed histologically as malignant. Notably, benign conditions such as seborrhoeic keratosis were frequently referred via both pathways. Basal cell carcinoma (BCC) was referred to as USC, despite guidelines recommending routine referral for most BCC cases. This suggests substantial overuse of the urgent pathway. Outcomes showed that 83.7% of patients were managed without requiring face-to-face appointments. About 44.6% were discharged with reassurance, 20.9% underwent minor surgery, and 1.3% required referral to surgical specialities due to lesion complexity or location. Only 15.6% were seen in "see and treat" clinics. Discussion The data underscore a significant issue of inappropriate urgent referrals for benign skin conditions, contributing to delays and resource strain in secondary care. Contributing factors include limited dermatology training in primary care, fear of misdiagnosis, and patient pressure. Enhancing GP education, developing standardised referral guidelines, and improving access to dermoscopic imaging tools in primary care could help mitigate these challenges. Teledermatology not only enhances diagnostic accuracy but also offers cost savings, with previous local studies estimating a reduction of £43 per patient. Conclusion The rising incidence of skin cancer, coupled with limited dermatology training for primary care providers, fear of misdiagnosis, and patient anxiety, strains dermatology services. Our study demonstrates that appropriate referrals to teledermoscopy service will help optimise outpatient resources and facilitate prompt treatment for patients with suspected high-risk skin cancers.