Why is teledermatology good for urgent advice about a mole, skin lesion or rash?
The Medical Chambers Kensington is currently the only private clinic in London to offer Teledermatology. Teledermatology uses high quality medical images to diagnose dermatological conditions. Most of the time we can see patients at very short notice and usually deliver the diagnosis within 48 hours. So treatment can be started as soon as possible, if needed.
We talk to Dr Veronique Bataille, Consultant Dermatologist at the clinic, about the benefits of teledermatology for patients looking for a quick and easy way to get an expert opinion.
Why might you recommend teledermatology to a patient who’s considering it for the first time?
It’s ideal for a mole or a single lump or bump that has appeared recently and is causing you concern. It’s also very useful for urgent advice about a rash, as our healthcare assistants who are specially trained in teledermatology will take your history to understand if there are any obvious triggers. Teledermatology is not useful for a full body check or if the rash comes and goes. It also doesn’t work for lumps under your skin as they don’t show up in photographs.
In the 14 years you've used teledermatology, what have you found to be the main benefits for patients?
Without doubt, the speed at which advice is delivered. Teledermatology is great because in many cases the patient can be reassured and offered temporary advice, even in cases where an appointment or a biopsy may be needed later on. Fast track to the right clinic is also great, because I can refer a patient directly to a plastic surgeon or other specialist if needed. Patients also love the PDF report including my advice and the photos, delivered by email within 48 hours.
Are there cases where a teledermatology consultation wouldn’t be appropriate?
Teledermatology isn’t suitable if your skin condition is chronic and you want advice about long term management. It’s also not appropriate for rashes or lumps and bumps in sensitive places, like the genital and anal areas, or for full skin checks and discussion about genetic risks such as a family history of skin cancer. If you have a rash and ae feeling ill it is not recommended as we will not be able to a take blood test, which may be needed.
What are the benefits of teledermatology consultations for you, the dermatologist?
Mainly the satisfaction that we are able to help anxious patients quickly, and speed up diagnosis and treatment. Doctors and patients often ring us for advice and hope that by sending poor quality photos without any history, we can reach a diagnosis. It just doesn’t work. We use a system specially designed for telediagnosis of skin lesions and rashes, so the clinical history and images are of optimal quality and we can deliver a much better diagnosis and better advice. We are always aware of the system’ s limitations so when we are not sure, we always ask to see the patient face to face.
Are there cases where you're not able to provide a proper assessment of a mole or rash?
Yes, when the mole/lump has been scratched and is bleeding, or is covered by a thick crust, so that the skin is not fully visible. Or, when the mole is in a tricky area and so hard to photograph. In these cases, we always recommend a face-to-face consultation. But this is rare as our healthcare assistants and nurses are well trained in dermoscopy imaging.
What’s the approximate percentage of patients that you have to ask to come back to the clinic for a biopsy or further investigation?
This figure isn’t yet available for private teledermatology. In the NHS, just under 30% of patients are told that their skin mole or lump is benign, and are reassured by teledermatology advice alone. Another 20% are recommended to see their GP for creams or other medications. The remainder may need a face to face consultation or a biopsy which can be arranged almost immediately, so the patient can have the minor procedure on the same day. But, the number of patients in the private sector who are reassured is likely to be higher than in the NHS, where they will have first been screened by their GP. Private clinic patients will not have been screened.
What has patients' feedback been on the eDerma service?
Very positive. Patients love the speed, the PDF with recommendations, the images and most of all the quick access to a highly experienced specialist. And a quick biopsy if needed.
Have you seen an improvement in the diagnostic capabilities of the service since you started using it?
The software has improved, providing a better background clinical history and better photographs. The new dermatoscopes we use give very clear, focused images. This helps a lot. The clinical data can also be easily audited on a regular basis, as all the suspected diagnoses, photos and outcomes can be stored for many years. This helps us to look at our diagnostic accuracy over time, and check that this system is safe.
You need to be an experienced dermatologist to do teledermatology referrals but many young dermatologists are now adopting teledermatology in the NHS and enjoy using it. However, like many skills it relies on pattern recognition and being able to tie it all together with a patient’s clinical history. Some dermatologists are more confident than others at working in this way. Personally, it has been a positive change in my practice. I have been doing it for a long time and look forward to continuing to offer it to my private patients.
To make an appointment with one of our Healthcare Assistants/Nurses please call 020 7244 4200.