The impact of store-and-forward teledermatology on skin cancer diagnosis and treatment.

Abstract

Although the diagnostic accuracy of teledermatology has been extensively studied, the clinical outcomes associated with teledermatology are still unclear. We examined the time intervals in which skin cancer patients referred conventionally or by store-and-forward teledermatology were evaluated, diagnosed, and treated. A chart review was performed of all patients who had been treated for skin cancer in a Veterans Affairs medical center's dermatologic surgery clinics as a result of a conventional dermatology or teledermatology referral from 3 remote primary care clinics over a 4.5 year period. One hundred sixty-nine patient cases met the study criteria (45.6% conventional referrals, 54.4% teledermatology referrals). For conventional and teledermatology referrals, respectively, the overall mean time intervals for initial consult completion were 48 and 4 days (p < .0001), for biopsy were 57 and 38 days (p = .034), and for surgery were 125 and 104 days (p = .006). Teledermatology consults were also associated with fewer dermatology clinic visits before surgery (p = .02). This was a retrospective study conducted on a Veterans Affairs healthcare system and a specific skin cancer patient population, which may not be directly comparable to other organizations. Clinical outcomes in skin cancer management via teledermatology, as measured by times to diagnosis and to surgical treatment, can be comparable to, if not better than, management by conventional referrals for remotely located patients.