BT15 Looking to the future: evaluation of outcomes of a teledermatology service pathway with an educational focus

Abstract Teledermatology implementation is increasing in response to rising demands for dermatology services across the UK. The teledermatology service at our local dermatology department was set up in August 2024. This study aimed to directly compare face-to-face (F2F) and teledermatology clinic outcomes, and to determine relevant educational needs in primary care. Data on Teledermatology and F2F referrals that met teledermatology criteria were collected and compared over 4 months. This included referrer role, referral date, photograph and virtual review date and outcome [discharge, refer for minor procedure (MOP) or F2F follow-up]. Data on clinical vs. histological diagnoses were compared over 1 month. Over 4 months, 340 referrals via the 2-week-wait (2WW) pathway were triaged to teledermatology. The average time from referral to image review was 20.4 days. Comparatively, 1476 referrals via 2WW were triaged to the F2F pathway, with an average waiting time of 23.4 days from referral to consultation. For teledermatology the top three clinical diagnoses were benign naevus (32%), seborrhoeic keratosis (23%) and uncertain (10%), with atypical moles and malignant melanoma accounting for 9% and 5%, respectively. Outcomes were 56% discharged, 38% MOP and 5% follow-up clinic. The most common direct discharge diagnoses were benign naevus (32%) and seborrhoeic keratosis (23%). A 1-month snapshot from September 2024 showed 112 teledermatology reviews, with 41 referrals for MOPs. Among those referred to MOPs, 41% had matching histopathological and clinical diagnoses, compared with 40% for F2F referrals (P = 0.48). Histology reports confirmed malignant lesions in three cases, therefore one in 14 lesions referred to MOPs were malignant. During the same period, 99 patients who met teledermatology criteria were instead seen via the F2F pathway. Of these, 35 were referred for MOPs, with six cases confirmed as malignant, meaning one in six F2F MOP referrals were for a malignant lesion. The F2F discharge rate was 57%, while the teledermatology discharge rate was 56%. In January 2025, only 5% of patients on the dermatological cancer patient tracking list waited > 21 days for their first appointment. This was a significant improvement from January 2024, when 57% of patients faced waits exceeding 21 days following a 2WW skin cancer referral. This study demonstrates that teledermatology has successfully reduced waiting times while maintaining comparable clinical outcomes to F2F consultations. Using the benign lesion data highlighted, we are implementing a regional targeted teaching project. This will involve an online module on skin lesion assessment for primary care practitioners, designed to improve diagnostic confidence and reduce benign lesion referrals.