Teledermatoscopy – mole assessment for everyone

By offering the possibility for everyone to have their skin lesions checked at their local healthcare centre, a more accessible and equal healthcare is created. The Dermatology Clinic as well as the primary care saw the need to expand the accessibility to mole assessment. 

The photograph is taken with the phone’s camera and is stored in an image storage system connected to the medical record. The primary care doctor sends a referral to the Dermatology Clinic with a reference to the images of the patient’s skin lesions. The dermatologist at the hospital judges whether or not the condition needs surgery, treatment or if it is best left unattended, based on the images. The patient and the doctor who sent the referral get feedback from the dermatologist after about a week after the images where taken. About 4500 teledermatoscope referrals are sent to the Dermatology Clinic each year. 

The pilot showed positive results and decision was made to implement the service model in all 40 healthcare centres in Region Västerbotten. Since then there has been continuous work with improving routines and work models. 

Despite the fact that the cost for dermatoscopes and smartphones was relatively low, about 1500 euros, it was decided that the central budgetary allocation for development would be used to finance the equipment for all healthcare centres. Taking the financial decision at a central level meant that the implementation could be done in a fast pace. 

Apart from establishing technical conditions, routines were also created. The routines included everything from how the patients were being photographed, to referral management and record keeping. An instructional film was produced that was used in the training of the staff. A number of training session with involved staff were performed at the three hospitals in the region. The implementation was done with the help of a project manager that was given a 30% employment. 

Two dermatologists has also taken a specific course in dermatoscopy - The Academic Expert in dermoscopy -. It is a two years postgraduate distance learning course for physicians  and nurses who wish to gain advanced expertise in the theoretical and practical diagnosis and management of skin tumors. Certificate of the Medical University of Graz. Granted the official title "Academic Expert in Dermoscopy". 

The cost for the training of the staff could be kept quite low since it was mainly done using an instructional film that was accessible online. 

Since Region Västerbotten already had a medical record with image storing possibilities there were no extra costs there.  

The work model also had support from the national work with standardized care processes and the project “Better flow for melanoma” run by the Swedish Association of Local Authorities and Regions, SKL.  

The politicians were also positive to replacing the referral-free mole assessment at the University Hospital in Umeå with the new work model where all healthcare centres could offer mole assessment.  

Continuous follow-up is also done on the number of referrals, to what extent pathological samples decline, time to diagnosis and surgery, the thickness of the melanoma, diagnostic accuracy, deviations in referral handling, the number of patient travels, times for standardized care processes etc.

The increase in the number of referrals has leveled off which might be due to the fact of increased competence to assess moles at the healthcare centres. The patients that have to undergo surgery at the hospitals have cancer diagnoses to a higher extent than earlier, which means that the resources are being used for the right patients. 

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Effects for the patient 

• Shorter time to diagnosis and possible action 
• More equitable healthcare throughout the county 
• Less travels 
• Fewer unnecessary operations, which is important since there is a lack of pathologists 
• Skin lesions are assessed by a dermatologist 

Effects for the care giver 

• More efficient processing of patients 
• Competence increase in the primary care 
• Early diagnosis which in the long run reduces treatment costs 
• Decreased strain on the Department of Pathology with benign lesions which allocates resources for managing cancer diagnoses 
• Screening of skin cancer has improved 

Other effects 

• Positive effects on the environment 
• Reduced costs for patient travels