Background: Melanoma is the top 10 cancer deaths in both female and male population in New Zealand (1). It was predicted that 90,400 New Zealanders would be diagnosed with at least one in situ or invasive keratinocytic skin cancers (BCC and SCCs) (2). There is a huge pressure on the current healthcare system to accommodate the high referral rates of skin cancer. A teledermatoscopy service was established in Waikato DHB, where patients attended nurse-led clinics for the imaging of lesions and remote diagnosis by dermatologists.
Method: We evaluated the waiting times and diagnoses of skin lesions for all patient visits from 2010 till 2019. The relationships between patient characteristics and the diagnosis of melanoma were statistically analyzed.
Result:The teledermatoscopy clinic was attended by 6479 patients for 11,005 skin lesions on 8805 occasions. Statistically significant risk factors for the diagnosis of melanoma and melanoma in situ were male sex (P<.001), European ethnicity (P=.001), an age of 65 to 74 years (P=.001), and Fitzpatrick skin type 2 (P=.001). The seasonal variations in visits from 2011 to 2018 revealed a consistent peak at the end of summer. In the year 2010, 76.1% (233/306) of these patients were discharged to primary care, and 23.9% (73/306) were referred to a hospital for a specialist assessment (plastics surgery or dermatology). The median waiting time for an imaging appointment was 44.5 days and median waiting time for first treatment was 63 days. The most common lesions diagnosed were benign naevus (2933/11,005, 26.7%), benign keratosis (2576/11,005, 23.4%),and keratinocytic cancer (1707/11,005, 15.5%).
Conclusion: This study is by far the largest patient group and longest duration of teledermoscopy studies reported in NZ. This study has shown the value of teledermatoscopy service in providing efficient and convenient access to specialist service and prevent unnecessary skin excision in primary care.