[Usefulness and efficiency of teledermoscopy in skin cancer management in primary care]

Abstract

Objective: To evaluate the usefulness of teledermoscopy as a diagnostic and triage method for suspected skin cancer lesions between Primary Care and Dermatology. To analyse the reduction in the number of referrals and estimate the savings achieved.

Material and methods: Concordance study on a non-randomised case series. Descriptive observational study of teleconsultations sent from two Health Centres (urban and rural) to the reference Dermatology service in Cordoba (Spain) between January 2017 and April 2019. The diagnoses proposed by Primary Care before and after the use of dermatoscopy, and the diagnosis of the Dermatologist, along with other epidemiological variables were collected. Descriptive analysis and concordance study were performed.

Results: A total of 395 teleconsultations were made. The coefficient of agreement between the diagnoses of both specialists without using dermoscopy was 0.486. Using this technique the concordance was 0.641. A reduction in the number of referrals to Dermatology was 58%. A savings of 2,475€ in transfers by ambulance and 550 working hours were made. The most common diagnoses were basal cell carcinoma (20%; n=79) and seborrheic keratosis (15.2%; n=60).

Conclusions: The addition of dermoscopy increases diagnosis concordance. Teledermatology is a useful system for patient triage and for decreasing the demand for hospital care, with an inherent resources saving.

Keywords: Atención primaria; Cáncer de piel; Dermatoscopia; Dermoscopy; Detección precoz; Early detection; Primary care; Skin cancer; Teledermatology; Teledermatología; Telemedicina; Telemedicine.