Sekaran Arvindh, Vetsiou Evangelia, Shah Ashka, Khoo Andre
Internal Medicine, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, GBR.
Dermatology, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, GBR.
Cureus. 2024 Aug 31;16(8):e68284. doi: 10.7759/cureus.68284. eCollection 2024 Aug.
Teledermatology utilises telecommunications technology to deliver dermatological care remotely, incorporating live video consultations, store-and-forward systems, and hybrid approaches. It is particularly valuable in underserved or remote areas with limited access to dermatologists. Reported benefits include reduced face-to-face consultations for benign lesions, leading to increased capacity for severe cases, improved access for rural patients, and enhanced satisfaction among clinicians and patients. The COVID-19 pandemic accelerated the adoption of teledermatology, integrating it into the National Health Service (NHS) framework for managing referrals and ensuring continuity of care. This study examines the outcomes of two-week wait referrals for suspected skin cancer, focusing on diagnostic concordance between teledermatology and histopathology.
The study was conducted at Addenbrooke's Hospital, part of Cambridge University Hospitals, via a retrospective review of patient records from November 2022 to May 2023. Inclusion criteria were all patients referred by their general practitioner (GP) under the two-week wait for suspected skin cancer pathway. Data collected included patient demographics, waiting times, clinical and histological diagnoses, and patient re-referrals for the same problem. The primary objective was to assess diagnostic concordance between the clinical diagnosis from teledermatology and histopathology. Secondary objectives included accuracy of lesion site description, patient waiting times, and computed time savings from the use of teledermatology.
The study covered 71 patients (34 males, 37 females) aged 19-87 years (mean: 59.63), with Fitzpatrick skin I-III predominating. A total of 110 individual lesions were assessed, and 46 required surgical management. Clinical and histological concordance was 62%, with 100% accuracy for basal cell carcinoma (BCC) and melanoma. The service saved 10 hours of consultant time and reduced the need for 62 initial face-to-face consultations. Lesion site documentation had a 73% correlation between GPs and dermatologists. Diagnoses varied widely between GPs and dermatologists, with a 31% concordance.
Our study shows that teledermatology is a safe and effective method for managing two-week wait referrals for suspected skin cancer, reducing footfall, and saving time and costs for both clinicians and patients. While there are limitations, the usage of teledermatology allows increasingly limited capacity for face-to-face consultations to be reserved for high-risk patients. Further studies in different regions should explore teledermatology's utility across diverse demographics, particularly to address healthcare disparities for those with darker skin tones.
远程皮肤病学利用电信技术远程提供皮肤病护理，包括实时视频会诊、存储转发系统和混合方法。在皮肤科医生就诊机会有限的服务不足或偏远地区，它尤其有价值。报告的益处包括减少良性病变的面对面会诊，从而增加重症病例的诊治能力，改善农村患者的就医机会，以及提高临床医生和患者的满意度。2019冠状病毒病疫情加速了远程皮肤病学的采用，将其纳入英国国家医疗服务体系（NHS）的转诊管理框架并确保护理的连续性。本研究考察疑似皮肤癌两周等待期转诊的结果，重点关注远程皮肤病学诊断与组织病理学诊断之间的一致性。
本研究在剑桥大学医院旗下的阿登布鲁克医院进行，通过回顾2022年11月至2023年5月的患者记录。纳入标准为所有由全科医生（GP）按照疑似皮肤癌途径在两周等待期内转诊的患者。收集的数据包括患者人口统计学信息、等待时间、临床和组织学诊断，以及因同一问题再次转诊的情况。主要目的是评估远程皮肤病学临床诊断与组织病理学诊断之间的一致性。次要目的包括病变部位描述的准确性、患者等待时间，以及使用远程皮肤病学节省的计算时间。
该研究涵盖71名患者（34名男性，37名女性），年龄在19 - 87岁之间（平均59.63岁），以Fitzpatrick皮肤I - III型为主。共评估了110个个体病变，其中46个需要手术治疗。临床与组织学一致性为62%，基底细胞癌（BCC）和黑色素瘤的诊断准确率为100%。该服务节省了10小时的会诊时间，并减少了62次初始面对面会诊的需求。全科医生与皮肤科医生之间病变部位记录的相关性为73%。全科医生与皮肤科医生的诊断差异很大，一致性为31%。
我们的研究表明，远程皮肤病学是管理疑似皮肤癌两周等待期转诊、减少就诊人次、为临床医生和患者节省时间和成本的一种安全有效的方法。尽管存在局限性，但远程皮肤病学的使用使越来越有限的面对面会诊能力能够留给高危患者。不同地区的进一步研究应探索远程皮肤病学在不同人群中的效用，特别是解决肤色较深人群的医疗差距问题。
