Dermatology – Primary Care
TRAINING VIDEO – PCDS Skin Lesion Assessment including Dermatology:
Download the presentation here (PDF 14mb)
Digital Dermatology Pathway
Increasing use of Digital Dermatology pathways remains part of the PCN DES for 2023/24.
We are starting to see increased use of Digital Dermatoscope images across both Fast Track Suspected Cancer referrals and Basal Cell Carcinoma (BCC) referrals throughout NENC ICB. This has been instrumental for the improvement of the Fast Track Suspected Cancer referrals skin pathway performance. Additionally, attachment of images within BCC referrals can help to pick up misdiagnosed Squamous Cell Carcinomas (SCCs) and ensure that they are brought into the correct pathway and receive much quicker treatment.
Practices and PCNs may wish to review their processes and procedures with regards to digital dermatology and could consider Skin Cancer Fast Track Suspected Cancer referrals a focus for the PCN DES Quality Improvement Project.
This Quality Improvement work could help to identify and share best practice and helpful tips to improve these processes and referrals throughout the PCN.
Where to keep the Dermatoscope?
Practices will have various processes for maintaining and storing the Dermatoscope, whilst ensuring it is readily available when required by staff.
Multiple skin lesions:
When photographing several lesions, it is useful to send an accuRx SMS per lesion (3 photos per SMS), and add the lesion location within the SMS text area to identify the lesion. This can help the admin teams if you have both a BCC and SCC referral, for example, to know which images to attach to which referral.
Using clinical staff v administrative staff to take the photographs:
Some practices have trained administrative staff to take the images and the clinical staff direct patients to have their photos taken (either sit and wait or via appointments) prior to the referral being completed and sent. The Dermatoscope location, charging and maintenance can be more closely controlled in these systems, especially in smaller teams. This can take the time pressure off the clinical staff and has little impact on clinical outcomes if good accessibility. Marking the skin lesions to be photographed with a pen is good practice.
Issues can occur when the responsibilities for the Dermatoscope are not clear within the practice team.
Practice Dermatoscope protocol example:
Admin Station Model: One suggestion, is the ensure that the Dermatoscope is kept at a specific admin station (one which is always manned) and this member of staff is made responsible for the checking and charging of the iPhone and Dermatoscope attachment, at the start of the day and throughout the day.
They can also keep a register of the “time” and “room” that the equipment is “signed out” to. Staff taking the scope should be reminded to return the equipment as soon as possible for others to use. New staff coming to find the Dermatoscope will be able to locate it easily, even if it hasn’t been returned swiftly.
On returning the Dermatoscope, it is good practice to recharge both the iPhone and Dermatoscope attachment.
If any issues with the equipment are flagged by the administrator on checking or other staff, then take appropriate steps e.g. report / escalate to initiate repair.
Using a suitable box for the equipment to protect against damage.
Stickers that clearly display the iPhone telephone number, email address, and iPhone Passcode on the box and the iPhone are also helpful.
Runner Model: Larger practices may want to consider Clinicians requesting the dermatoscope from Admin, and then Admin bring the equipment to them. They will wait until photos are taken and bring the equipment back for checks and charge. This is similar to a chaperone model. This could save considerable time for the clinician and ensure that the whereabouts and responsibilities for the equipment are always clear.
Referral Quality Improvement: Digital Dermatology example
Training resources:
The Cunliffe (TP) General Dermatology Diagnosis Tool is a visual diagnostic tool for inflammatory skin conditions and other rashes. Also hair, nail, oral and genital conditions
The Cunliffe (TP) General Dermatology Diagnostic Tool
Skin Cancer Training Module (Gateway C)
CSI NoT Digital Dermatology Teamnet
ABCDEFG of melanoma – DERMNET NZ
Down the presentation here (PDF 14mb)