DS22: The impact of using teledermatology versus face-to-face reviews when seeing patients that are referred via the 2-week wait pathway for suspected cancers, and overcoming some of the barriers in the new COVID era

Charankumal Singh Thandi,¹ Lizzy Wasson,² Rebecca Mountain,¹ Danielle Bruchez,¹ Ifrah Omar³ and Matthew Ridd³

¹Bristol Royal Infirmary, Bristol, UK; ²Liverpool Royal University Hospital, Liverpool, UK; and ³University of Bristol, Bristol, UK

Teledermatology is an increasingly used method to review 2-week wait (suspected cancer) referrals following the COVID-19 pandemic. It is important to be aware of the impact this may have compared with traditional face-to-face reviews and therefore our project compared 50 patients seen face to face vs. 50 patients who were reviewed by teledermatology. A systematic review in 2011 showed that teledermatology led to reduced referral waiting times, but concluded that the diagnostic accuracy was lower for malignant lesions. We reviewed 100 patients at our hospital to investigate the differences in methods of assessing these patients. Retrospective data were collected via Medway, to look at the clinical outcome of patients that were seen in January 2019 (face to face and pre-COVID-19) vs. June 2020 (telephone consultations during the COVID-19 pandemic) at our hospital. The data were inputted into Microsoft Excel and analysed. The referral regions covered included Bristol, Weston-Super-Mare, Wells and Taunton. Further data analysis is ongoing to look at the types of investigations that were done, and to evaluate the differences in investigations done when comparing melanoma skin cancer and nonmelanoma skin cancer. In January 2019, 58% of patients were discharged. In June 2020, 32% of patients were discharged and 34% needed to be rebooked into another appointment owing to a poor quality photo or no photo at all. In January 2019, 48% of patients had an investigation, whereas in June 2020, 56% of patients had an investigation. From the patients investigated in January 2019, 46% of patients had cancer and, in June 2020, 32% of patients who were investigated had a confirmed skin cancer. It is important to be aware of the factors that may impact clinician decisions when reviewing patients via teledermatology as research has already suggested that using remote assessment may be more likely to suggest excision, referral or follow-up after telephone reviews (Chuchu N, Dinnes J, Takwoingi Y et al. Teledermatology for diagnosing skin cancer in adults. Cochrane Database Syst Rev 2018; 12: CD013193). More research is needed on a larger scale to review the impact of using more teledermatology as opposed to traditional face-to-face review. We also need to address barriers to teledermatology, including geographical variation, economic and training costs, and patient preferences.