Outcomes of Risk-Stratified Face-to-Face and Teledermoscopy Pathways for Skin Lesion Referrals: A Retrospective Service Evaluation.
Teledermoscopy referral pathway associated with higher discharge rate than face-to-face clinics
Outcomes of Risk-Stratified Face-to-Face and Teledermoscopy Pathways for Skin Lesion Referrals: A Retrospective Service Evaluation.
Skin cancer referrals to secondary care continue to rise, and teledermoscopy has been incorporated into NHS urgent suspected cancer (urgent suspected cancer) pathways to support triage.
We retrospectively compared outcomes across two risk-stratified referral pathways within the same dermatology service over a six-month period (July-December 2025): 201 patients with 207 index lesions assessed via FTF clinics, and 378 patients with 415 lesions assessed via teledermoscopy.
more patients needed no further specialist care after photo-based skin checks than in-person clinics
FTF referrals were predominantly urgent suspected cancer referrals (175/201, 87.0%), with a malignancy yield of 57/207 index lesions (27.5%).
The discharge rate was 72/201 patients (35.8%), and 116/201 patients (57.7%) required minor operative procedures.
Teledermoscopy referrals were more evenly distributed across urgency categories, with 193/378 patients (51.1%) referred as urgent suspected cancer.
Incidental lesions were identified in 25/201 FTF assessments (12.4%), of which 24/25 (96.0%) were skin cancers, predominantly basal cell carcinomas.
Within the same service and assessing consultant, teledermoscopy was associated with a substantially higher discharge rate while still detecting skin cancers across referral categories.
Much of this difference likely reflects image-based triage allocating lower-suspicion referrals to teledermoscopy, rather than a difference in diagnostic performance between the two modalities; these findings should be interpreted as a descriptive evaluation of pathway throughput rather than a head-to-head comparison of diagnostic accuracy.