Overview

The NCL teledermatology service enables referring GPs to send a referral and images (photographs) to the provider and receive a timely diagnosis and management plan for patients with a skin lesion or rash of diagnostic uncertainty. This provides GPs with rapid access to a specialist opinion on diagnosis and management, thereby reducing unnecessary referrals to secondary care.

See the Downloads section below for the NCL teledermatology pathway; the document also includes inclusion/exclusion criteria.

See Related Videos for topic-specific dermatology webinars.

Image requirements for rashes and lesions

Patients with rashes can send their own images to the practice, avoiding the need for them to attend the practice.

Patients with lesions must attend an appointment at the practice so that dermoscopic images can be taken; this is for both referrals to e-RS and Consultant Connect.

You can also download the teledermatology image guidelines from the Downloads section below.

2WW skin referrals

The number of two-week wait (2WW) skin referrals in NCL has significantly increased, leading to service delays. NCL providers are working together to manage capacity constraints. 

In NCL, less than three per cent of 2WW skin referrals are diagnosed with melanoma or squamous cell carcinoma (SCC); the rest are lower-risk basal cell carcinoma (BCC) or benign.

If your index of suspicion is low but you are not totally sure, you can seek Consultant Connect teledermatology Advice and Guidance (A&G), and your query will be reviewed with a response received within 24 hours. Please ensure that you include the correct images as per the image requirement guidelines. Alternatively, you can consider referring via teledermatology, as response times are now much improved and concerning lesions will be upgraded to 2WW.

If your index of suspicion is high, please refer via the normal face-to-face 2WW pathway.

See the Cancer (2WW): Indicative wait to first appointment data page for more information.

See also the webinars on how to identify benign skin lesions and how to identify malignant lesions.

Teledermatology training

• Drop in session recording: Overview of teledermatology pathway, dermoscopy, Consultant Connect and teledermatology referral pathway (1 February 2022, see slides in Downloads)
• How to use the DermLite DL3N to take images
• Consultant Connect app for dermatology A&G and e-RS teledermatology referral assistance
• NCL teledermatology collaboration session.

For equipment issues, contact Steven Michaels at Schuco.
e: steven.michaels@schuco.co.uk
t: 019 2323 4600

Eligibility Criteria

Inclusions

• aged 16+ and registered with an NCL GP.

Exclusions

Please note: The NCL EBICS policy still applies; teledermatology is not required for minor skin lesions where funding is approved.

Lesions:

• patients with suspected melanoma, squamous cell carcinoma or any other suspicious rapidly enlarging lesion within 4-8 weeks (includes rapidly increasing basal cell carcinomas) should be referred using the 2WW pathway.

Rashes:

• all patients with acute onset and/or rapidly spreading severe rashes involving >50% of body surface area should be referred urgently to the on call SpR.

The following patients should be referred routinely to the Dermatology service:

• paediatric patients (15 years old and under) 
• patients with anogenital skin lesions
• patients without capacity to make informed decisions/consent to photography/understand the English language
• patients previously diagnosed with melanoma and/or non-melanoma skin cancer and that would benefit from a total body face-to-face examination
• patients with more than three lesions for review (as these warrant a full body check); this also includes patients for mole mapping   
• patients with immunosuppression
• patients with a severe skin disease or chronic dermatological condition previously seen in secondary care and known to require secondary care input
• patients whose condition is not amenable to photographic imaging (e.g. Hyperhidrosis)
• for lesions and rashes:
  • where the GP has previously been given Advice and Guidance which has not worked
  • where the GP has sent an image to Consultant Connect and they have suggested a face-to-face appointment is required (however if it is a lesion and dermatoscopic image is not submitted, image should be submitted first before making the referral).

See the Downloads section below for the NCL teledermatology pathway; the document also includes inclusion/exclusion criteria.

How to Refer

Locations

UCLH Dermatology Service

Whittington Health Dermatology Service

Royal Free Dermatology Service