title: Successful melanoma triage by a virtual lesion clinic (teledermatoscopy).
abstract: BACKGROUND
  A Virtual Lesion Clinic (VLC) using teledermatoscopy was established to improve efficiency of the melanoma referral pathway.
  
  
  OBJECTIVE
  To assess diagnostic accuracy and to compare wait-times and costs of VLC and conventional clinics.
  
  
  METHODS
  Patients with suspected melanoma referred from primary care into a publicly funded health system attended local skin imaging centres, rather than hospital outpatient clinics. A teledermatologist assessed each lesion choosing specialist assessment/excision, General Practitioner (GP) follow-up, to re-image in 3 months, or self-monitoring/no concern.
  
  
  RESULTS
  613 skin lesions in 310 patients were evaluated over 12 months. Median time between receipt of referral and attendance at the VLC was 9 days compared to 26.5 days for standard outpatient assessment. Sixty-six percent (404/613) of lesions were considered benign, and 12% (73/613) were suspicious for melanoma. Of 129 lesions excised, 98 were skin cancers including 48 histologically confirmed melanomas with one spitzoid tumour of unknown malignant potential (STUMP), i.e. one melanoma per 1.59 suspected lesions biopsied and one melanoma in every 12.8 referred to the service. There were 49 non-melanoma skin cancers (NMSC). Teledermatoscopic diagnosis of melanomas was found to have a positive predictive value (PPV) of 63%. Compared to the conventional clinic, cost reductions from running the VLC for 1 year were in excess of NZ$364,000 (or NZ$1174/patient seen).
  
  
  CONCLUSIONS
  The VLC offered an efficient, accurate and cost effective way of processing suspected melanoma referrals to the public health system.
authors.affiliation: Department of Cutaneous Oncology, Waitemata District Health Board, Auckland, New Zealand.
authors.forename: A T
authors.initials: AT
authors.lastname: Congalton
authors.affiliation: University of Auckland, Auckland, New Zealand.|Department of Dermatology, Waikato District Health Board, Hamilton, New Zealand.
authors.forename: A M
authors.initials: AM
authors.lastname: Oakley
authors.affiliation: University of Auckland, Auckland, New Zealand.|Department of Dermatology, Waikato District Health Board, Hamilton, New Zealand.
authors.forename: M
authors.initials: M
authors.lastname: Rademaker
authors.affiliation: Waitemata District Health Board, Auckland, New Zealand.
authors.forename: D
authors.initials: D
authors.lastname: Bramley
authors.affiliation: Department of Cutaneous Oncology, Waitemata District Health Board, Auckland, New Zealand.
authors.forename: R C W
authors.initials: RC
authors.lastname: Martin
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002280:Basal Cell Carcinoma / Q000473:pathology*; D002294:Carcinoma, Squamous Cell / Q000473:pathology*; D017046:Cost Savings; D046169:Dermoscopy / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008545:Melanoma / Q000473:pathology* / Q000601:surgery; D008875:Middle Aged; D009520:New Zealand; D011237:Predictive Value of Tests; D012017:Referral and Consultation; D012878:Skin Neoplasms / Q000473:pathology* / Q000601:surgery; D017216:Telemedicine / Q000191:economics; D013997:Time Factors; D014218:Triage / Q000191:economics / Q000379:methods*; D014850:Waiting Lists; D055815:Young Adult