Safeguarding skin cancer services with the use of teledermatology

Dr Amy Poyner, a GP on the Isle of Wight with a special interest in surgical dermatology, highlights how technology has improved the process for skin cancer diagnosis and ensured referrals continue as normal during the COVID-19 pandemic

Teledermatology services are helping to ensure patient pathways are uninterrupted on the Isle of Wight

Like every part of the NHS, the Isle of Wight has been doing everything it can to respond to the demand on services following the outbreak of COVID-19.

Quite rightly, a significant amount of resource, investment and commitment has been put into helping the health service treat those with the virus.

However, understandably, there are growing concerns about patients receiving vital services that aren’t related to COVID-19, for example cancer diagnosis and treatment.

And, in the Isle of Wight, melanoma diagnoses are three times higher than the national average, and non-melanoma skin cancer is five times higher.

The recent pandemic has demonstrated additional benefits of the remote technology and online collaboration that we couldn’t have predicted when we started this initiative

Coupled with this, the island has two part-time visiting dermatologist consultants, who live on the mainland, and an over-stretched resource in primary care, caused partly by the higher-than-average population of elderly residents.

Safeguarding services

But the Dermicus Teledermatology Assessment Service that was introduced last year has ensured that patients with a suspicious skin lesion can be seen by their GP and referred to a dermatologist for diagnosis, without any delays caused by coronavirus.

The very nature of the teledermatology set-up, supplied by Gnosco, has ensured the service has been safeguarded during these unprecedented times.

Photos of the skin lesion are taken by a GP or advanced nurse practitioner on a phone with an attached dermascope and are sent quickly, easily and securely to a clinician, along with the patient’s medical notes to review and make a diagnosis remotely.

The online platform where the information is accessed also allows for collaboration between healthcare professionals without any need for physical contact.

And, in spite of one of the visiting dermatologists recently having to self isolate, there has not been any delays to the two-week wait time for a skin cancer diagnosis as the clinician was able to review his caseload as normal on the Dermicus collaboration platform.

Likewise, GP practices have been able to access the diagnosis on the same platform, as normal, and subsequently follow the appropriate action with patients.

Transforming the patient pathway

The digital-first approach has not only enabled healthcare professionals to protect vital services during such unprecedented times, but also to maintain the significantly-improved patient pathway achieved as a result of deploying the Dermicus service last year.

Since implementation the NHS has seen the time it takes from GP referral to dermatologist review reduce exponentially.

Whereas the collective wait time for all dermatology referrals is normally about four weeks on the Island, this has been reduced to less than a week.

And there is no doubt that this has enabled us to identify skin cancers much faster than before, and importantly, to introduce treatment pathways earlier, which in some cases will have implications for overall survival rates from the original cancer.

The approach has also provided an additional safety net within GP practices, by minimising the risk of melanomas and non-melanoma skin cancers being included in routine referrals to dermatology, which are managed along a much-slower timeline.

It has also improved the accuracy of referrals from GP practices, particularly from practitioners with less experience in dermatology.

Finally, and most importantly, there’s the significant impact on our patients’ experience with the service and their mental wellbeing during this very-traumatic and worrying time.

The digital-first approach has not only enabled healthcare professionals to protect vital services during such unprecedented times, but also to maintain the significantly-improved patient pathway achieved as a result of deploying the Dermicus service last year

And feedback has shown that patients think it has improved the skin examination, and the fast-and-easy process has added a significant level of reassurance at a much-earlier stage.

Additionally, it has reduced the need for patients to take time off work to attend the referral appointment, or for the elderly and most vulnerable to travel to the clinic to be seen.

Planning for the future

It was clear before COVID-19 how effective the new service had been in improving care for our patients, but the recent pandemic has demonstrated additional benefits of the remote technology and online collaboration that we couldn’t have predicted when we started this initiative.

Without Dermicus, we would have had to temporarily stop some of these services and rapidly plan alternative workarounds.

It’s why we think it’s so important to continue to scale the use of technology in our health services, and will be looking to extend the teledermatology service to all dermatology needs on the island.

We are also considering introducing Gnosco’s telemedicine service for woundcare, so that a much-wider part of our community can benefit from these vital services, and importantly, we can continue to safeguard these services now, and in the future.

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