Histopathological outcomes of teledermatology-based assessment for cutaneous melanoma: analysis of patient care flow

Teledermatology (TD) can increase access to specialists, reducing unnecessary referrals and waiting time for dermatologist consultations. This study aimed to analyze the flow of patient care through a TD system for cutaneous melanoma (CM), using histopathological diagnosis as the reference standard. Observational study including all cases with a diagnostic hypothesis of CM seen between 2015 and 2019, who attended the public TD system in Florianópolis and Joinville, cities located in a Brazilian state characterized by a high incidence of CM. Clinical assessments performed by primary care physicians and teledermatologists were compared with available histopathological reports, which were considered the definitive diagnostic reference. Among the 912 hypotheses of CM indicated by the primary health care team, 111 (12.2%) were validated by the teledermatologist. Further 289 suspected cases were identified by the teledermatologist based on the analysis of different primary care hypotheses, totaling 400 lesions compatible with CM. Of these, 190 (47.5%) histopathological reports were validated and there were 51 confirmed cases. Using histopathological diagnosis as the reference standard, the positive predictive value of the teledermatologist’s assessment was 26.8%. In Florianópolis, the interval between primary care consultation and teledermatologist assessment or histopathological report was 30.4 or 95.4 days, respectively. These intervals could not be defined in Joinville because the TD system was filled out after the primary care consultation. The median interval between teledermatologist assessment and histopathological diagnosis was 89.9 days considering both cities. The use of TD increased by 312% during the study period, without a corresponding increase in diagnostic agreement between primary care physicians and teledermatologists. Teledermatology contributed to the diagnostic pathway of cutaneous melanoma by facilitating access to specialist assessment and reducing unnecessary referrals; however, histopathological examination remained indispensable for definitive diagnosis. The high proportion of suspected cases without histopathological confirmation highlights a relevant loss to diagnostic follow-up, particularly among older patients.