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Clinical Report

Smartphone Teledermoscopy Referrals: A Novel Process for Improved Triage of Skin Cancer Patients

doi: 10.2340/00015555-1906


In this open, controlled, multicentre and prospective observational study, smartphone teledermoscopy referrals were sent from 20 primary healthcare centres to 2 dermatology departments for triage of skin lesions of concern using a smartphone application and a compatible digital dermoscope. The outcome for 816 patients referred via smartphone teledermoscopy was compared with 746 patients referred via the traditional paper-based system. When surgical treatment was required, the waiting time was significantly shorter using teledermoscopy for patients with melanoma, melanoma in situ, squamous cell carcinoma, squamous cell carcinoma in situ and basal cell carcinoma. Triage decisions were also more reliable with teledermoscopy and over 40% of the teledermoscopy patients could potentially have avoided face-to-face visits. Only 4 teledermoscopy referrals (0.4%) had to be excluded due to poor image quality. Smartphone teledermoscopy referrals allow for faster and more efficient management of patients with skin cancer as compared to traditional paper referrals.


Alexander Börve, Johan Dahlén Gyllencreutz, Karin Terstappen, Eva Johansson Backman, Anette Aldenbratt, Markus Danielsson, Martin Gillstedt, Carin Sandberg, John Paoli


1. The Swedish Cancer Registry of the National Board of Health and Welfare. [Cancer incidence in Sweden 2012]. 2014 [cited 2014 Mar 30]. Available from (in Swedish).

2. The Swedish Cancer Registry of the National Board of Health and Welfare. Basal cell carcinoma in Sweden 2004–2008. 2009 [cited 2014 Mar 30]. Available from (in Swedish).

3. Paoli J, Börve A, Dahlen J, Gillstedt M, Sandberg C, Terstappen K. [Smartphone application for more effective management of skin cancer patients]. Distriktsläkaren 2012; 2: 24–27 (in Swedish).

4. Moreno-Ramirez D, Ferrandiz L, Nieto-Garcia A, Carrasco R, Moreno-Alvarez P, Galdeano R, et al. Store-and-forward teledermatology in skin cancer triage: experience and evaluation of 2009 teleconsultations. Arch Dermatol 2007; 143: 479–484.

5. Morton CA, Downie F, Auld S, Smith B, van der Pol M, Baughan P, et al. Community photo-triage for skin cancer referrals: an aid to service delivery. Clin Exp Dermatol 2011; 36: 248–254.

6. Tan E, Yung A, Jameson M, Oakley A, Rademaker M. Successful triage of patients referred to a skin lesion clinic using teledermoscopy (IMAGE IT trial). Br J Dermatol 2010; 162: 803–811.

7. Warshaw EM, Hillman YJ, Greer NL, Hagel EM, MacDonald R, Rutks IR, et al. Teledermatology for diagnosis and management of skin conditions: a systematic review. J Am Acad Dermatol 2011; 64: 759–772.

8. Borve A, Terstappen K, Sandberg C, Paoli J. Mobile teledermoscopy-there’s an app for that! Dermatology Pract Concept 2013; 3: 41–48.

9. Lim D, Oakley AM, Rademaker M. Better, sooner, more convenient: a successful teledermoscopy service. Australas J Dermatol 2012; 53: 22–25.

10. Knol A, van den Akker TW, Damstra RJ, de Haan J. Teledermatology reduces the number of patient referrals to a dermatologist. J Telemed Telecare 2006; 12: 75–78.

11. van der Heijden JP, de Keizer NF, Bos JD, Spuls PI, Witkamp L. Teledermatology applied following patient selection by general practitioners in daily practice improves efficiency and quality of care at lower cost. Br J Dermatol 2011; 165: 1058–1065.

12. Aldridge RB, Naysmith L, Ooi ET, Murray CS, Rees JL. The importance of a full clinical examination: assessment of index lesions referred to a skin cancer clinic without a total body skin examination would miss one in three melanomas. Acta Derm Venereol 2013; 93: 689–692.

13. Viola KV, Tolpinrud WL, Gross CP, Kirsner RS, Imaeda S, Federman DG. Outcomes of referral to dermatology for suspicious lesions: implications for teledermatology. Arch Dermatol 2011; 147: 556–560.

14. Mahendran R, Goodfield MJ, Sheehan-Dare RA. An evaluation of the role of a store-and-forward teledermatology system in skin cancer diagnosis and management. Clin Exp Dermatol 2005; 30: 209–214.

15. Liu W, Dowling JP, Murray WK, McArthur GA, Thompson JF, Wolfe R, et al. Rate of growth in melanomas: characteristics and associations of rapidly growing melanomas. Arch Dermatol 2006; 142: 1551–1558.

16. Tejera-Vaquerizo A, Barrera-Vigo MV, Lopez-Navarro N, Herrera-Ceballos E. Growth rate as a prognostic factor in localized invasive cutaneous melanoma. J Eur Acad Dermatol Venereol 2010; 24: 147–154.

17. Ferrandiz L, Ruiz-de-Casas A, Martin-Gutierrez FJ, Peral-Rubio F, Mendez-Abad C, Rios-Martin JJ, et al. Effect of teledermatology on the prognosis of patients with cutaneous melanoma. Arch Dermatol 2012; 148: 1025–1028.

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Volume 95, Issue 2

DOI: 10.2340/00015555-1906

Pages: 186-190

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