ABSTRACT
The COVID-19 pandemic limited the ability to do conventional outpatient patient face-to-face consultations. New patient skin cancer referrals could not be postponed while awaiting resolution of the COVID-19 pandemic. Photographs taken by patients and community physicians are of ranging quality, adding to the challenge of teledermatology triaging. A new pilot was designed to aid skin cancer triage with professional medical photography images of lesions to be taken in the community setting to avoid patients attending hospital during the COVID-19 pandemic. All consecutive 2-week-wait skin cancer referrals were included over a 2-week period in May 2020 during the peak of the national COVID-19 pandemic. Patients were automatically allocated an appointment time with the medical photography department, in a specifically set up community location. On arrival, patients were given a screening questionnaire with details requested about the nature of their lesion. Professional images were taken and loaded onto the patient's medical illustrations record. Patients were triaged by dermatology consultants based on their general practice referral details, patient questionnaire and professional image. The triage options included booking straight to surgery, clinic appointment or discharge. Patients were then called by a medical professional and informed of the triage outcome. Over the 14-day period, 122 patients were referred to the dermatology department. Mean age was 57 years (range 16-93). One patient was excluded owing to being a child;two patients did not attend their appointment. On allocation of a medical photography appointment, five patients declined to attend and were subsequently booked into clinic. The triage discharge rate was 35.1% (n = 40), with 20.2% (n = 23) being booked directly to a dermatology surgery list, and 43.8% (n = 50) allocated a clinic appointment. Histopathological correlation of the suspected triage diagnosis was confirmed in 72% of patients. Of those seen in the face-to-face clinic, dermatology surgery was subsequently requested in 38% (n = 19). Community-based medical illustration appointments reduced the requirement for patients to attend hospital during the national COVID-19 pandemic. The high-quality images of referred suspected skin cancer lesions, combined with a patient questionnaire, allowed for patients to be promptly remotely triaged, with a higher than previously documented discharge rate vs. standard face-to-face consultation. Patient satisfaction was high, with rapid surgery allocation dates and quick-response triage. Patients with benign conditions were able to be discharged without the risk of having to attend hospital. Triaging consultants reported that triage time was quicker than standard clinic consultation time, which was a further important factor during a time of staff shortages, with illness and redeployment.