Teledermatology

Teledermatology in East Devon

The Royal Devon & Exeter Dermatology Department provide a teledermatology service via e-Referrals. This service allows GPs to seek advice from a consultant dermatologist by sending relevant clinical information along with digital photographs of the area/s of concern via e-Referrals advice and guidance functionality. The service offers rapid dermatology diagnosis and management advice from a Consultant-led team, within 1-3 working days. The expanded service aims to offer a one day reporting turnaround for the majority of patients.

The service should be particularly useful for elderly patients living in nursing or residential homes who may find it difficult to travel. For these patients GPs should consider taking a digital camera or smartphone with a camera to their consultations (note the photography guidance).

With consent from the patient, clinical photographs can be taken in the consultation using either a home or practice digital camera or a smartphone camera. The teledermatology consent form has been updated (see link below) to reflect recent UK guidance on the use of mobile photographic devices / smartphones for teledermatology.

Teledermatology inclusion criteria:
  • adults and children with skin disease including rashes and skin lesions
  • non-melanoma skin cancer (basal cell carcinoma or squamous cell carcinoma)
Exclusions:
  • suspected melanoma
  • pigmented skin lesions for the exclusion of melanoma
  • please refer to the 2 Week Wait service
Teledermatology provides Advice and Guidance

The teledermatology service offers a diagnosis and management plan based on the images provided. Teledermatology referrals will not be converted into face-to-face referrals unless requested by the GP referrer (with the exception of non-melanoma skin cancers surgical triage referrals)

How do I triage a patient with non-melanoma skin cancer for skin surgery using NHS e-Referral teledermatology?
  • Take localising and close-up images of the suspected skin cancer, showing the body site and surrounding anatomy.
  • Please ensure that the patient has had a total skin examination in primary care if indicated as patients triaged directly to a skin surgery list will not routinely undergo a total skin examination to screen for additional skin lesions, whereas this service is offered in the face-to-face dermatology skin cancer clinic.
  • Please confirm in your referral that you are happy for the patient to be triaged directly for skin surgery in the Dermatology Department.
  • Include a full list of medications
  • Please specify if the patient has a pacemaker or implantable defibrillator device.
  • Patients will be sent preoperative information in the post and booked directly onto an appropriate surgical list.
Which patients are not suitable for teledermatology surgical triage?
  • Patients with low risk basal cell carcinomas – please refer to the community dermatology skin surgery services
    • Low risk: not head and neck (eg below the clavicle), under 2 cm in diameter, patients over 24 years, patient not immunosuppressed.
  • Patients with large non-melanoma skin cancers which are likely to require complex repair with skin grafting or Mohs surgery. These patients can be referred via teledermatology but will be triaged for an initial consultation in an appropriate dermatology or plastic surgery clinic if clinically indicated.

Referral

Referral Instructions

e-Referral Service Selection:

  • Request Type: Advice
  • Specialty: Dermatology
  • Service: Tele - Dermatology - for Advice & Guidance only - RDE-RH8

Supporting Information

References

  1. UK Guidance on the use of mobile photographic devices in dermatology (2017).
    1. http://www.bad.org.uk/shared/get-file.ashx?itemtype=document&id=5774
  2. Quality Standards for Teledermatology: Using 'Store and Forward' Images (2013), Primary Care Commissioning
    1. www.bad.org.uk
Teledermatology Service information

Dr Carolyn Charman, Consultant Dermatologist - Royal Devon and Exeter NHS Foundation Trust

NHS e-Referral Teledermatology support

NHS Devon Clinical Commissioning Group

Photographic advice

Graham Slocombe, Medical Photographer - Royal Devon and Exeter NHS Foundation Trust

Last updated: 19-06-2020

 

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