JMIR Publications

ABSTRACT

Background:

Challenges remain for general practitioners (GPs) in diagnosing (pre-)malignant and benign skin lesions. Teledermoscopy (TDsc) supports GPs in diagnosing these skin lesions guided by the teledermatologists’ (TDs) diagnosis and advice and prevents unnecessary referrals to dermatology care. However, the impact of the availability of TDsc on GPs’ self-reported referral decisions to dermatology care before and after the TDsc consult is unknown.

Objective:

To assess and compare the initial self-reported referral decisions of GPs before TDsc versus their final self-reported referral decisions after TDsc for skin lesions diagnosed by the TD as (pre-)malignant and benign.

Methods:

TDsc consultations requested by GPs in daily practice between July 2015 and June 2020 with a TD assessment and TD diagnosis were extracted from a nationwide Dutch telemedicine database. Based on GP self-administered questions, the GPs’ referral decisions before and their final referral decision after TDsc consultation were assessed for (pre-)malignant and benign TD diagnoses.

Results:

GP self-administered questions and TD diagnoses were evaluated for 6,364 TDsc consultations (9.3% malignant, 8.8% pre-malignant and 81.9% benign skin lesions). In half of the TDsc consultations, GPs adjusted their initial referral decision after TD advice and TD diagnosis. Initially, GPs did not have the intention to refer 67 (56.8%) out of 118 patients with a malignant TD diagnosis and 26 (16.0%) out of 162 patients with a pre-malignant TD diagnosis and the GPs adjusted their referral decision to referral after the TDsc consultation. Further, the GPs adjusted their referral decision from referral to non-referral for 2,534 (74.9%) benign skin lesions (including 676 seborrheic keratosis and 131 vascular lesions).

Conclusions:

GPs adjusted their referral decision in fifty percent of the TDsc consultations after the TD assessment. The availability of TDsc is thus of added value and assists GPs in their referral decisions of patients with skin lesions to dermatology care. TDsc resulted in referrals of patients with (pre-)malignant skin lesions that GPs would not have referred directly to the dermatologist and in a reduction of unnecessary referrals to the dermatologist of patients with low complex benign skin lesions (e.g., seborrheic keratosis and vascular lesions).