Teledermoscopy-Assisted Referral for Cutaneous Melanoma: Diagnostic Timeliness, Histopathologic Severity, and Stage at Excision in a Comparative Cohort

Background/Objectives: Teledermoscopy may improve melanoma triage by accelerating specialist review and compressing the time to definitive treatment, but its clinical relevance depends on whether faster access is accompanied by detection at a less advanced stage. This study compared teledermoscopy-assisted and conventional referral pathways for cutaneous melanoma as a pathway-level service evaluation. Methods: In this single-center observational cohort, 87 patients with histologically confirmed primary cutaneous melanoma were analyzed, including 43 managed through teledermoscopy-assisted referral and 44 through a conventional pathway. Primary outcomes were time from referral to dermatology consultation, biopsy, and definitive excision. Secondary outcomes included Breslow thickness, mitotic rate, ulceration, stage distribution, early-stage disease, and selected pathway-quality indicators. Results: Teledermoscopy-assisted referral was associated with shorter median times to consultation (9.0 vs. 18.7 days), biopsy (16.6 vs. 30.3 days), and excision (26.9 vs. 43.2 days), all p < 0.001. Patients in the teledermoscopy group had lower Breslow thickness (0.7 vs. 1.5 mm, p < 0.001), lower mitotic rate (1.2 vs. 2.9 mitoses/mm2, p < 0.001), a higher proportion of stage 0/I melanoma (79.1% vs. 40.9%; risk ratio 1.93, 95% CI 1.31–2.85), and fewer lesions with Breslow > 2.0 mm (9.3% vs. 36.4%; risk ratio 0.26, 95% CI 0.09–0.70). Conclusions: In this non-randomized cohort, teledermoscopy-assisted referral was associated with faster melanoma care and a more favorable stage profile at excision. Because pathway assignment was not randomized and lesion-level referral urgency was incompletely measured, these findings should be interpreted as associations that support further prospective evaluation rather than as proof of causal stage migration.