P168 Efficacy and outcomes of the 2-week-wait teledermatology pathway in a cohort of 1000 patients

Abstract Teledermatology has become a widely accessible service nationwide over the last few years, intending to facilitate specialist advice for community services, expedite suspected skin cancer pathways, and prioritize the backlog of patients facing long waiting lists. Between August 2023 and August 2024, our dermatology department received around 7913 2-week-wait (2WW) referrals, 5415 of which required a face-to-face (F2F) outpatient appointment, and 2498 were reviewed by teledermatology service. The review aimed to establish whether teledermatology is effective in managing 2WW referrals. A retrospective analysis was conducted of 1000 patients on the 2WW pathway, seen first through the teledermatology service between April and September 2023. Clinical letters and the outcomes of appointments were thoroughly assessed, and the histological report published in the electronic system was reviewed. Of the 1000 cases reviewed, 382 (38.2%) patients (156 in 2WW and 226 routine appointments) were seen in F2F clinics. Overall, 298 (29.8%) were discharged, and 285 (28.5%) were booked directly for surgical excision. Thirty-five (3.5%) patients did not attend. In total, 171 (17.1%) were referred directly for a 2WW excision. Of the 1000 patients, 156 (15.6%) were rescheduled for a 2WW F2F appointment; 58 (5.8%) were then referred for a 2WW excision. In total, 229 patients (22.9%) were scheduled for a 2WW excision. Histological outcomes revealed that out of these 229 (22.9%) patients, 24 (10.5%) had melanoma, 6 (2%) had SCC, and 31 patients (13.5%) were diagnosed with BCC. Overall, 106 patients (46%) listed for 2WW excision were diagnosed with a benign condition. Our review showed that teledermatology effectively manages the 2WW referrals in our department, with 58.3% of referred patients not requiring a F2F review. Annual conversion rates in the UK suggest that around 5–10% of all 2WW referrals for skin cancers are malignant. Our 1000-patient review demonstrated a conversion rate of 6.3% of all 2WW referrals. Reasons patients were required to be reviewed in a F2F clinic included high-risk patients, multiple lesions photographed, referral and photo mismatch, and inadequate history in the initial referral letter. While the teledermatology service is vital in prioritizing 2WW referrals, it can be further enhanced to reach its main objectives. Our proposed recommendations include improving the referral quality from primary care physicians through adherence to set referral criteria. Additionally, setting up an urgent biopsy pathway to manage less urgent conditions like BCC, keratoacanthoma, atypical naevus and pyogenic granuloma is beneficial. Ensuring all photos submitted to the service meet the photography referral guidelines to ensure appropriate quality control is crucial.