Over 100,000 cases of skin cancer are diagnosed in the UK each year and it is estimated that about half of all dermatology referrals are for assessment of skin lesions. Teledermatology has been welcomed in many areas as a tool that could help triage such referrals, however, debate continues amongst dermatologists as to how safe teledermatology is when used for this purpose. A study1 presented at the at the British Association of Dermatologists’ Annual Conference in Birmingham this week (July 3rd to 5th), hopes to answer that question.

The team from the University of Edinburgh looked at previous studies but concluded that they did not reveal the answer to the critical question which was to understand how many ‘incidental’ skin cancers might be missed by assessing only a single ‘index’ lesion. (In plain English the ‘index lesion’ is the one that you show either to your GP or to the camera (in the case of teledermatology). An ‘incidental lesion’ is one that is picked up during examination or treatment of the ‘index lesion’.)

A study was set up at a UK district general hospital and participants for the study were enrolled from those attending a fortnightly skin lesion clinic2. The study revealed that just over half of the melanomas detected were incidental – i.e. not the referred skin lesion but ones that had been identified during a total body skin examination – which forms a routine part of the index lesion evaluation. Comparing the ratio of incidental to index melanomas the team found that their results were similar to other studies, despite geographical and demographic differences.

The results suggest that isolated single lesion teledermatology triage cannot be considered as an adequate replacement to a total body skin examination performed by a competent practitioner.

Ben Aldridge, Clinical research fellow in Dermatology at the University of Edinburgh and one of the authors of the study, says “Teledermatology could be a useful tool for the referral pathway, but further research is needed to determine the exact practitioner, patient and lesion criteria that will allow it to be incorporated safely, in the meantime if used in isolation, teledermatology triage is likely to miss important skin malignancies.”

The study corroborates the opinions voiced in the annual teledermatology survey of BAD members, which is also presented at the conference3, where 60% of BAD members stated that they did not support teledermatology being used in isolation for the assessment of lesions.

-Ends-
Notes to editors:

If using this study, please ensure you mention that the study was released at the British Association of Dermatologists’ Annual Conference.
The conference will be held at ICC Birmingham, 3rd to 5th July 2012, and is attended by approximately 1,300 UK and worldwide dermatologists and dermatology nurses.

For more information please contact: Deborah Mason, British Association of Dermatologists, Communications Manager, Phone: 0207 391 6355 or 07957 145992 (mobile during conference week only), Email: deborah@bad.org.uk, Website: www.bad.org.uk

1. Study details: “Teledermatology triage of suspicious skin lesions potentially could be missing the majority of melanomas”; R B Aldridge, L Naysmith, E T Ooi, C Murray and J Rees, Department of Dermatology, University of Edinburgh, UK

2. The study was undertaken at a U.K. district general hospital that serves a defined geographical population. All patients who attended a fortnightly skin lesion clinic over a 9-month period between January and October 2010 were prospectively asked to participate, and 336 patients agreed to enrol in the study. This represents 91% (336/370) of the total eligible patients who attended the clinics over this period. The patients (n = 34) who did not participate all had benign index lesions and no incidental malignancies. In addition to recording the details of the index (referral) lesions, further data were collected on all incidental lesions that required a biopsy. These incidental lesions were identified during total body skin examinations (TBSE), which we offer routinely at the time of index lesion evaluation. Most melanomas (5/9; 56%) detected were incidental and not the referred index lesion. In all of these incidental melanomas the index lesion had been benign.

3. “Love it or loathe it? Results of the 2011 British Teledermatology Survey”, N.J. Levell, C.R. Charman* and S.M. Halpern†, Norfolk and Norwich University Hospital, Norwich, *Royal Exeter and Devon Foundation NHS Trust, Exeter and †Medway NHS Foundation Trust, Gillingham, U.K.