BT14 Diamonds in the rough: patient-captured images can be used to triage out benign lesions

Abstract

Abstract Dermatology is struggling with 2-week-wait (2WW) cancer referrals, resulting in a lack of capacity to review other dermatoses. National data indicate that only 6% of the 500 000 referrals are confirmed skin malignancies (www.england.nhs.uk/wp-content/uploads/2022/04/B0829-suspected-skin-cancer-two-week-wait-pathway-optimisation-guidance.pdf), and our local data suggest that 40% of referrals are, in fact, benign, with 24% being seborrhoeic keratoses. Could there be a way to triage these lesions safely? Novel consumer-level smartphone attachments could be the way forward. Patient-led teledermatology has proven to be a convenient, environmentally friendly way of assessing cutaneous lesions. Dermoscopic modalities such as the Molescape™ and Dyplens™ show promise in facilitating the triage of skin lesions, but have we really established the efficacy of these devices first-hand with our local patient cohorts? Studies suggest that the resolution and clarity of these images are comparable to clinical dermatoscopes. To challenge this theory, we obtained patient-led dermoscopic images of lesions that were referred under the 2WW pathway. We then allocated a blinded dermatology consultant to analyse these images (n = 50) for diagnoses and proposed management plan, based on the patient-captured image and brief history. We compared the proposed diagnoses with histological and clinical outcomes for those 50 patients. We found an accuracy of 78% vs. in-person assessment, but, most importantly, all benign lesions, including seborrhoeic keratoses, were excluded safely. All malignancies were triaged as suspicious with the use of these simple devices, with basal cell carcinomas (n = 3) being diagnosed with 100% accuracy. Could these smartphone attachments be the answer to improved national triaging pathways? We may have found a solution. However, will this affect patient expectation, experience and satisfaction? Surprisingly, our local survey revealed that 80% of our 2WW patients would prefer these devices as opposed to attending primary care or photograph clinics. We appreciate that patient-led dermoscopy may not have the accuracy needed to diagnose complex cutaneous lesions, and these will always warrant prompt clinical review. However, these pioneering devices may be the solution to filtering out simple benign lesions, preventing unnecessary hospital footfall and reducing carbon footprint. In keeping with the contemporaneous goals set by the National Health Service COVID-19 recovery plan, these innovative devices should be considered as part of our existing triage pathways, to help optimize skin cancer triage and treatment and to better patient care.