Dermatology
Pathways
This page predominantly focuses on good practice and education for digital dermatology and distinguishing between benign and malignant skin lesions.
Digital dermatoscope images are increasingly used for urgent suspected cancer and BCC referrals, across the North East and North Cumbria ICB. This helps streamline skin cancer pathways for faster diagnosis, treatment and improved patient experience.
Skin lesions – clinical assessment
Follow the links below for training and guidance on skin lesion assessment:
👉 Dr Tim Cuncliffe – differentiating benign from malignant skin lesions
👉 PCDS – the Cuncliffe (TP) general dermatology diagnostic tool
Digital dermatology pathway
Teledermatology quality improvements – continuous review and updates on digital dermatology practices, quality standards and processes are an essential components of the PCN Cancer DES requirements. These improvements help to streamline referrals and diagnostics, ensuring an efficient teledermatology pathway.
The approaches below can help you to improve and maintain good practice. A ready-made digital dermatology QI project overview can be found 👉 here.
Securing quality images and effective processes
In summary when photographing lesions:
- Use alcohol gel to improve image quality.
- Take three images:
1 Dermatosope image
2 Standard photo from 20cm away from the lesion
3 “Site” image from further away to highlight the location of
the lesion on the body.
- Consider marking the lesion with a pointer (or finger) on the wider photo if surrounded by other skin lesions to reduce confusion.
- Ensure that the photographs taken are NOT Check images for clarity using the accuRx app or the journal within EMIS/Systmone, after taking the image.
- Encourage secretaries to verify image quality and provide feedback if blurred. Empower them to feedback to clinicians if they are not of a good quality. (Feedback loops will improve quality).
- Some practices have trained non-clinical staff to take photos, reducing pressure on clinical staff. Lesions of concern are clearly marked for the staff to photograph. The dermatoscope location, charging and maintenance can be more closely controlled in these systems, especially in smaller teams.
- If a patient has more than one concerning skin lesions, it is unlikely that they will be suitable for a triage appointment. Please refer for a face-to-face clinic appointment, and document “more than one lesion” as the reason for no telederm images.
Dermatoscope protocols
Each practice should ensure the dermatoscope is easily accessible and properly maintained. Issues can occur when the responsibilities for the dermatoscope are not clear within the practice team. To follow are two examples of systems within GP Surgeries:
Admin Station Model: ensure the dermatoscope is stored at a designated admin station (which is always supervised). Assign a member of staff responsibility for equipment charging, maintenance, and logging usage i.e. time and room the equipment is signed out to, to track it if not returned. The admin is also responsible for reporting any faults promptly.
Runner Model: In larger practices, clinicians can request the dermatoscope from designated admin staff, who deliver it, wait for images to be taken (like the chaperone model) and return it to the storage point to recharge and maintain. This model saves clinician time and keeps track of the equipment.
Top tips
- After each use, recharge both the iPhone and dermatoscope.
- Report or escalate any equipment issues to designated admin.
- Store in a protective box to reduce damage.
- Use stickers to show the device’s phone number, email and passcode.
Training resources
We have collated a comprehensive suite of teledermatology training resources:
👉 Differentiating benign from malignant skin lesions
👉 Teledermatology technology demonstration
👉 Taking a good clinical image
