P161 How safe are community lesion imaging clinics for teletriage of suspected skin cancer? A retrospective study

Abstract We have previously reported significant system benefits associated with community lesion imaging clinics (CLICs) for teletriage of suspected skin cancers. CLICs are a low-cost model for dermatology triage run by healthcare assistants in community locations, with images and data subsequently reviewed in a ‘store and forward’ manner by dermatologists. This study followed up patients discharged from CLIC teletriage in an attempt to identify skin cancers erroneously diagnosed as benign and discharged following teletriage. Records of patients who had been discharged directly from teletriage were reviewed 6–12 months after their CLIC appointment to identify whether there had been further contact with dermatology. We then reviewed the reason for contact and subsequent histopathology results, where applicable, to assess whether there had been a change in diagnosis, missed malignancy or additional skin cancer diagnosed. In total, 1485 consecutive patients referred on the suspected skin cancer pathway attended a CLIC between December 2023 and May 2024. Of these, 350 of 1485 (23.6%) were discharged to their general practitioner (GP) following teletriage, and 1 of 1485 (0.07%) was given an open appointment for 6 months. Of this cohort, 229 (65.4%) were female and their median age was 65 years (interquartile range 56–75). The median follow-up period was 247 days (range 194–344). In 39 of 351 cases (11.1%), GPs contacted our department following discharge from the teledermatology service. Three of 39 contacts were due to the incorrect photo being taken in the CLIC. Six of 39 contacts were queries regarding topical treatments for the lesions discharged. Twelve of 39 contacts were referrals for review of another lesion. Eighteen of 39 contacts requested re-review of the original lesion. Six contacts led to a change in diagnosis, with four of these cases changing from benign to malignant diagnoses [one missed MM, one squamous cell carcinoma (SCC) and two basal cell carcinomas (BCCs)]. Five of 351 patients (1.4%) had an incidental skin cancer diagnosed on further review but not related to the initial referral lesion (5 BCCs, 1 SCC). Overall, a skin cancer was missed in 4 of 1485 (0.3%) patients seen in the CLIC teledermatology service. These results compare favourably with cancer miss rates following face-to-face review with a dermatologist. Further research might focus on measures to further reduce missed cancers in teledermatology services, including development of high-performance artificial intelligence triage tools.