{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,14]],"date-time":"2026-05-14T04:51:06Z","timestamp":1778734266686,"version":"3.51.4"},"reference-count":41,"publisher":"MDPI AG","issue":"22","license":[{"start":{"date-parts":[[2021,11,20]],"date-time":"2021-11-20T00:00:00Z","timestamp":1637366400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100001529","name":"Waikato Medical Research Foundation","doi-asserted-by":"publisher","award":["324"],"award-info":[{"award-number":["324"]}],"id":[{"id":"10.13039\/501100001529","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Cancers"],"abstract":"<jats:p>We undertook a retrospective comparison of two teledermatology pathways that provide diagnostic and management advice for suspected skin cancers, to evaluate the time from referral to diagnosis and its concordance with histology. Primary Care doctors could refer patients to either the Virtual Lesion Clinic (VLC), a nurse-led community teledermoscopy clinic or, more recently, to the Suspected Skin Cancer (SSC) pathway, which requires them to attach regional, close-up, and dermoscopic images. The primary objective of this study was to determine the comparative time course between the SSC pathway and VLC. Secondary objectives included comparative diagnostic concordance, skin lesion classification, and evaluation of missed skin lesions during subsequent follow-up. VLC referrals from July to December 2016 and 2020 were compared to SSC referrals from July to December 2020. 408 patients with 682 lesions in the VLC cohort were compared with 480 patients with 548 lesions from the 2020 SSC cohort, matched for age, sex, and ethnicity, including histology where available. Median time (SD) from referral to receipt of teledermatology advice was four (2.8) days and 50 (43.0) days for the SSC and VLC cohorts, respectively (p &lt; 0.001). Diagnostic concordance between teledermatologist and histopathologist for benign versus malignant lesions was 70% for 114 lesions in the SSC cohort, comparable to the VLC cohort (71% of 122 lesions). Referrals from primary care, where skin lesions were imaged with variable devices and quality resulted in faster specialist advice with similar diagnostic performance compared to high-quality imaging at nurse-led specialist dermoscopy clinics.<\/jats:p>","DOI":"10.3390\/cancers13225828","type":"journal-article","created":{"date-parts":[[2021,11,21]],"date-time":"2021-11-21T20:58:21Z","timestamp":1637528301000},"page":"5828","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":11,"title":["Remote Skin Cancer Diagnosis: Adding Images to Electronic Referrals Is More Efficient Than Wait-Listing for a Nurse-Led Imaging Clinic"],"prefix":"10.3390","volume":"13","author":[{"given":"Leah","family":"Jones","sequence":"first","affiliation":[{"name":"Waikato District Health Board, Hamilton 3204, New Zealand"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7068-4311","authenticated-orcid":false,"given":"Michael","family":"Jameson","sequence":"additional","affiliation":[{"name":"Waikato District Health Board, Hamilton 3204, New Zealand"},{"name":"Waikato Clinical Campus, University of Auckland, Hamilton 3204, New Zealand"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9461-2790","authenticated-orcid":false,"given":"Amanda","family":"Oakley","sequence":"additional","affiliation":[{"name":"Waikato District Health Board, Hamilton 3204, New Zealand"},{"name":"Waikato Clinical Campus, University of Auckland, Hamilton 3204, New Zealand"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2021,11,20]]},"reference":[{"key":"ref_1","unstructured":"(2020, October 01). Population Pyramids of the World from 1950 to 2100. Available online: https:\/\/www.populationpyramid.net\/new-zealand\/."},{"key":"ref_2","unstructured":"(2021, September 09). Selected Cancers 2015, 2016, 2017, Available online: https:\/\/www.health.govt.nz\/publication\/selected-cancers-2015-2016-2017."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"208","DOI":"10.1111\/j.1440-0960.2007.00388.x","article-title":"Extremely high levels of melanoma in Tauranga, New Zealand: Possible causes and comparisons with Australia and the northern hemisphere","volume":"48","author":"Salmon","year":"2007","journal-title":"Australas. J. Dermatol."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"1161","DOI":"10.1016\/j.jid.2016.01.035","article-title":"The growing burden of invasive melanoma: Projections of incidence rates and numbers of new cases in six susceptible populations through 2031","volume":"136","author":"Whiteman","year":"2016","journal-title":"J. Investig. Dermatol."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"1706","DOI":"10.1158\/1055-9965.EPI-08-0682","article-title":"Melanoma in Maori, Asian, and Pacific peoples in New Zealand","volume":"18","author":"Sneyd","year":"2009","journal-title":"Cancer Epidemiol. Biomarkers Prev."},{"key":"ref_6","first-page":"61","article-title":"Incidence, demographics and surgical outcomes of cutaneous squamous cell carcinoma diagnosed in Northland, New Zealand","volume":"131","author":"Elliott","year":"2018","journal-title":"N. Z. Med. J."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"210","DOI":"10.1111\/ajd.12751","article-title":"The burden of non-melanoma skin cancers in Auckland, New Zealand","volume":"59","author":"Pondicherry","year":"2018","journal-title":"Australas. J. Dermatol."},{"key":"ref_8","unstructured":"Rowan, D., Lamb, S., Greig, D., Keefe, M., Chan, W.C., Koo, W., Agnew, K., Giles, A., and Graves, B. (2021, August 16). Health Workforce New Zealand Dermatology Workforce Service, Available online: https:\/\/www.health.govt.nz\/system\/files\/documents\/pages\/dermatology-workforce-service-forecast-nov14.docx."},{"key":"ref_9","unstructured":"Ministry of Health (2021, September 28). Population of Waikato DHB, Available online: https:\/\/www.health.govt.nz\/new-zealand-health-system\/my-dhb\/waikato-dhb\/population-waikato-dhb."},{"key":"ref_10","first-page":"841","article-title":"Teledermatology in the times of COVID-19\u2014A systematic review","volume":"18","author":"Elsner","year":"2020","journal-title":"J. Dtsch. Dermatol. Ges."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"803","DOI":"10.1111\/j.1365-2133.2010.09673.x","article-title":"Successful triage of patients referred to a skin lesion clinic using teledermoscopy (IMAGE IT trial)","volume":"162","author":"Tan","year":"2010","journal-title":"Br. J. Dermatol."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"22","DOI":"10.1111\/j.1440-0960.2011.00836.x","article-title":"Better, sooner, more convenient: A successful teledermoscopy service","volume":"53","author":"Lim","year":"2012","journal-title":"Australas. J. Dermatol."},{"key":"ref_13","first-page":"112","article-title":"9-year review of Waikato Teledermatoscopy Service (abstract). Proceedings of the Waikato Clinical Campus Biannual Research Seminar","volume":"132","author":"Teoh","year":"2019","journal-title":"N. Z. Med. J."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"147","DOI":"10.1111\/ajd.13230","article-title":"E-referrals and teledermatoscopy grading for melanoma: A successful model of care","volume":"61","author":"Sunderland","year":"2020","journal-title":"Australas. J. Dermatol."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"2423","DOI":"10.1111\/jdv.13309","article-title":"Successful melanoma triage by a virtual lesion clinic (teledermatoscopy)","volume":"29","author":"Congalton","year":"2015","journal-title":"J. Eur. Acad. Dermatol. Venereol."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"856","DOI":"10.1111\/bjd.13722","article-title":"Mobile teledermatology is here to stay","volume":"172","author":"Oakley","year":"2015","journal-title":"Br. J. Dermatol."},{"key":"ref_17","first-page":"2374373521996982","article-title":"Pandemic pressure: Teledermatology and health care disparities","volume":"8","author":"Rustad","year":"2021","journal-title":"J. Patient Exp."},{"key":"ref_18","doi-asserted-by":"crossref","unstructured":"Maddukuri, S., Patel, J., and Lipoff, J.B. (2021). Teledermatology addressing disparities in health care access: A review. Curr. Dermatol. Rep., 1\u20138.","DOI":"10.1007\/s13671-021-00329-2"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"75","DOI":"10.1177\/1357633X16686770","article-title":"The use of teledermoscopy in the accurate identification of cancerous skin lesions in the adult population: A systematic review","volume":"24","author":"Bruce","year":"2018","journal-title":"J. Telemed. Telecare"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"132","DOI":"10.1258\/1357633001935202","article-title":"Teledermoscopy: Results of a multicentre study on 43 pigmented skin lesions","volume":"6","author":"Piccolo","year":"2000","journal-title":"J. Telemed. Telecare"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"644","DOI":"10.1001\/jamadermatol.2017.0204","article-title":"Creation of an internal teledermatology store-and-forward system in an existing electronic health record: A pilot study in a safety-net public health and hospital system","volume":"153","author":"Carter","year":"2017","journal-title":"JAMA Dermatol."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"293","DOI":"10.1016\/j.jaad.2017.09.017","article-title":"Impact of dermatology eConsults on access to care and skin cancer screening in underserved populations: A model for teledermatology services in community health centers","volume":"78","author":"Naka","year":"2018","journal-title":"J. Am. Acad. Dermatol."},{"key":"ref_23","unstructured":"(2021, August 24). Urban Rural Profile Categories. Available online: https:\/\/www.otago.ac.nz\/healthsciences\/otago706060.pdf."},{"key":"ref_24","first-page":"CD013193","article-title":"Teledermatology for diagnosing skin cancer in adults","volume":"12","author":"Chuchu","year":"2018","journal-title":"Cochrane Database Syst. Rev."},{"key":"ref_25","unstructured":"National Melanoma Tumour Standards Working Group (2021, November 03). Standards of Service Provision for Melanoma Patients in New Zealand\u2014Provisional. Available online: https:\/\/www.melnet.org.nz\/uploads\/standards-of-service-provision-melanoma-patients-jan14.pdf."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"40","DOI":"10.1016\/j.jaad.2017.08.039","article-title":"Determination of the impact of melanoma surgical timing on survival using the National Cancer Database","volume":"78","author":"Conic","year":"2017","journal-title":"J. Am. Acad. Dermatol."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"1167","DOI":"10.1001\/jamadermatol.2019.1514","article-title":"Evaluation of the Number-Needed-to-Biopsy Metric for the Diagnosis of Cutaneous Melanoma. A Systematic Review and Meta-analysis","volume":"155","author":"Nelson","year":"2019","journal-title":"JAMA Dermatol."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"36","DOI":"10.1111\/ddg.14233","article-title":"Overdiagnosis of melanoma\u2014Causes, consequences and solutions","volume":"18","author":"Kutzner","year":"2020","journal-title":"J. Dtsch. Dermatol. Ges."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"398","DOI":"10.1001\/jamadermatol.2017.6448","article-title":"Dermoscopy and overdiagnosis of melanoma in situ","volume":"154","author":"Nufer","year":"2018","journal-title":"JAMA Dermatol."},{"key":"ref_30","first-page":"j3798","article-title":"Pathologists\u2019 diagnosis of invasive melanoma and melanocytic proliferations: Observer accuracy and reproducibility study","volume":"358","author":"Elmore","year":"2017","journal-title":"BMJ"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"319","DOI":"10.1001\/jamadermatol.2016.4361","article-title":"Teledermatology for the diagnosis and management of skin cancer: A systematic review","volume":"153","author":"Finnane","year":"2017","journal-title":"JAMA Dermatol."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"53","DOI":"10.1159\/000487924","article-title":"The \u201cdysplastic nevus\u201d conundrum: A look back, a peek forward","volume":"5","author":"Stefanato","year":"2018","journal-title":"Dermatopathology"},{"key":"ref_33","unstructured":"(2021, September 24). Age and Sex by Ethnic Group (Grouped Total Responses), for Census Usually Resident Population Counts 2006, 2013, and 2018 Censused (RC, TA, SA2, DHB), Available online: http:\/\/nzdotstat.stats.govt.nz\/wbos\/Index.aspx."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"1022","DOI":"10.1089\/tmj.2018.0130","article-title":"Use of teledermatology to improve dermatological access in rural areas","volume":"25","author":"Coustasse","year":"2019","journal-title":"Telemed. e-Health"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"652","DOI":"10.1089\/tmj.2011.0038","article-title":"Teledermatology via a social networking web site: A pilot study between a general hospital and a rural clinic","volume":"17","author":"Prado","year":"2011","journal-title":"Telemed. e-Health"},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"685","DOI":"10.1111\/ijd.12708","article-title":"Feasibility and cost of a medical student proxy-based mobile teledermatology consult service with Kisoro, Uganda, and Lake Atitl\u00e1n, Guatemala","volume":"54","author":"Greisman","year":"2015","journal-title":"Int. J. Dermatol."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"e9392","DOI":"10.2196\/jmir.9392","article-title":"Use of Smartphones for Early Detection of Melanoma: Systematic Review","volume":"20","author":"Rat","year":"2018","journal-title":"J. Med. Internet Res."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"e129","DOI":"10.1016\/S2589-7500(20)30001-7","article-title":"Accuracy of mobile digital teledermoscopy for skin self-examinations in adults at high risk of skin cancer: An open-label, randomised controlled trial","volume":"2","author":"Janda","year":"2020","journal-title":"Lancet Digit. Health"},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"265","DOI":"10.1001\/archdermatol.2010.2","article-title":"Increased risk of second primary cancers after a diagnosis of melanoma","volume":"146","author":"Bradford","year":"2010","journal-title":"Arch. Dermatol."},{"key":"ref_40","first-page":"323","article-title":"Development of multiple-lesion basal cell carcinoma of the skin: A comprehensive review","volume":"53","author":"Bartos","year":"2019","journal-title":"Sisli Etfal Hastan. Tip Bul."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"4337","DOI":"10.1038\/s41598-021-83502-8","article-title":"The incidence and clinical analysis of non-melanoma skin cancer","volume":"11","author":"Lange","year":"2021","journal-title":"Sci. Rep."}],"container-title":["Cancers"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2072-6694\/13\/22\/5828\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T07:33:21Z","timestamp":1760168001000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2072-6694\/13\/22\/5828"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,11,20]]},"references-count":41,"journal-issue":{"issue":"22","published-online":{"date-parts":[[2021,11]]}},"alternative-id":["cancers13225828"],"URL":"https:\/\/doi.org\/10.3390\/cancers13225828","relation":{},"ISSN":["2072-6694"],"issn-type":[{"value":"2072-6694","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,11,20]]}}}