Community photo-triage for skin cancer referrals: an aid to service delivery

C Morton, F Downie, S Auld, B Smith, Marjon Pol van der, P Baughan, J Wells, R Wootton

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28 Citations (Scopus)


We wished to investigate the potential for extending the capacity of the specialist service by using community-based photo-triage for suspected skin cancers.
To compare the outcomes and costs of conventional and photo-triage referral pathways.
This was an observational study of conventional and photo-triage referrals. Patients referred for initial photo-triage were invited to visit a medical photographer located in community health centres, who would take high-quality close-up and dermatoscopic images of the patients' lesions. A dermatologist then reviewed the images, and triaged patients to specific treatment clinics. All patients referred by conventional letter were offered initial appointments at the consultant-delivered skin cancer clinic. The difference in costs was assessed by modelling health service use under both pathways.
Photo-triage permitted 91% of patients (263/289) to achieve definitive care at first visit to the specialist team, compared with only 63% (117/186) via the conventional referral pathway. The mean waiting time to definitive treatment for patients with skin cancer was slightly reduced with photo-triage. Photo-triage permitted direct booking for 45% of patients to attend a nurse-delivered clinic, 22% to attend directly for surgery, 2% to attend a community general practice clinic and 2% to be referred on electronically to another specialty. This reduced by 72% the number of patients requiring attendance to the consultant clinic, freeing up capacity. Despite the cost of providing medical photography, there was a small cost saving of around £ 1.70 per patient using photo-triage.
Community photo-triage improved referral management of patients with suspected skin cancer, improving the delivery of definitive care at first visit and achieved an increased service capacity. Cost comparison found that the photo-triage model described was marginally cheaper than conventional care, and reduced hospital visits. An integrated primary-secondary care referral pathway that includes photo-triage facilitates a more efficient specialist service while ensuring that all suspicious lesions are viewed by an experienced dermatologist.
© The Author(s). CED © 2010 British Association of Dermatologists.
Original languageEnglish
Pages (from-to)248-254
Number of pages7
JournalClinical and Experimental Dermatology
Issue number3
Early online date10 Nov 2010
Publication statusPublished - Apr 2011

Bibliographical note

We thank R. Milligan MBE and Dr G. Gupta for early advice on setting up our pilot. We also thank J. Hunter, medical photographer, for his support in delivering the
service, and K. Bonnar and L. Baff for organizational support in the running of the triage service. Initial funding was supplied by the Scottish Centre for Telehealth.
The Health Economics Research Unit is funded by the Chief Scientist Office of the Scottish Government Health Directorates.


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